Mozambique: Score Justification Summary

2026

1.1 Antimicrobial resistance (AMR)

1.1.1 AMR surveillance, detection and reporting

1.1.1a National plan for AMR priority pathogens

Score: 100

Mozambique's National Action Plan Against Antimicrobial Resistance (AMR Plan, Plano Nacional de Acção Contra a Resistência Antimicrobiana 2019-2023) was issued by the Ministry of Health (MISAU) and the Ministry of Agriculture, the Environment, and Fisheries (MAAP, formerly known as the Ministry of Agriculture and Food Safety) in 2019. ¹ However, there plan is outdated. ² There is no evidence that it has been updated on the official websites of the Ministry of Health (MISAU), the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ³ ⁴ ⁵

The AMR Plan encompassed mechanisms for surveillance, detection, and reporting, and sets out six strategic interventions, one of which focuses on strengthening knowledge through surveillance and ensuring its sustainability through appropriate funding and research. ⁶ The proposed actions included: (i) establishing surveillance systems for monitoring antibiotic resistance and use; (ii) developing a surveillance programme for healthcare-associated infections in hospitals, with a particular focus on newborns and children under the age of five; (iii) assessing, designing, and implementing a AMR surveillance system that integrates data on antimicrobial use, resistance profiles, and antimicrobial residue levels in food products and the environment, contributing both to the development of a national database and to the WHO Global Antimicrobial Resistance Surveillance System; (iv) establishing sentinel laboratories to collect baseline and existing data on AMR, antimicrobial use, and residues across human, animal, and environmental health for integration into the national surveillance system; (v) regularly monitoring and reporting national surveillance data concerning humans, animals, and the environment through the governance structures of the AMR plan, at a minimum on an annual basis; (vi) establishing centres of excellence for training and research, both academic and applied, on AMR, while promoting continuous quality improvement; (vii) enhancing hospital laboratory capacity to detect outbreaks and antibiotic-resistant organisms, thereby supporting the effective implementation of infection prevention and control measures; and (viii) expanding the capacity of laboratories to detect microorganisms and analyse resistance patterns, as well as increasing the availability of microbiology laboratory services in underserved regions. ⁷

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 50

There is a laboratory system in Mozambique which tests for one priority AMR pathogen, namely zika.

The National Health Institute of Mozambique (INS, Instituto Nacional de Saúde) operates national laboratories dedicated to the research of specific pathogens, including the Zika virus. ⁸ The Viral Isolation Laboratory (LIV, Laboratório de Isolamento Viral) carries out surveillance and research activities related to various viral diseases, with a particular focus on respiratory viruses (such as influenza and respiratory syncytial virus), viral gastroenteritis and enteroviruses (including rotavirus, norovirus, astrovirus, and adenovirus), and emerging arboviruses in the country (such as dengue, chikungunya, Rift Valley fever virus, West Nile virus, Zika virus, and yellow fever). ⁹ The laboratory employs both traditional technologies (such as immunofluorescence microscopy, viral isolation in cell culture, and enzyme-linked immunosorbent assays – ELISA) and modern molecular methods. ¹⁰ Additionally, the laboratory participates in three international external quality assessment programmes (EQAPs) for rotavirus, influenza, and dengue. ¹¹

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

Mozambique does not conduct environmental detection or surveillance activities (e.g., in soil, waterways) for antimicrobial residues or AMR organisms.

There is no evidence that Mozambique conducts detection or surveillance activities in soil or waterways for antimicrobial residues or AMR organisms on the official websites of the Ministry of Health (MISAU), the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique), or the Ministry of Agriculture, the Environment, and Fisheries. ¹² ¹³ ¹⁴ ¹⁵

The Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016) states that the National Laboratory for Food and Water Hygiene performs routine microbiologic and chemical testing on food and water samples submitted for testing; however, there is no mention of antimicrobial residues or AMR organisms, and the detection or recording of events such as pesticide poisoning and maize flour contamination is poor, and surveillance is often not sensitive or timely enough to facilitate a rapid and thorough investigation or public health interventions to limit further illness. ¹⁶ It recommends strengthening laboratory capacity to detect microbial and chemical foodborne contamination. ¹⁷

The National Action Plan Against Antimicrobial Resistance (AMR Plan, Plano Nacional de Ação Contra a Resistência Antimicrobiana 2019–2023) includes a strategic intervention aimed at strengthening knowledge through surveillance and ensuring its sustainability through appropriate funding and research. ¹⁸ According to the AMR Plan, national surveillance systems must support the integrated “One Health” approach by tracking and identifying levels of antimicrobial residues in animals, animal-derived products, agriculture, and the environment, with the goal of informing prescribing practices and advocacy efforts. ¹⁹ However, there plan is outdated. ²⁰ There is no evidence that it has been updated on the official websites of the Ministry of Health (MISAU), the INS, or the INM. ²¹ ²² ²³

The National Regulatory Medicine Authority (ANARME, Autoridade Nacional Reguladora de Medicamento) published an activity report based on the AMR plan. ²⁴ However, it is not accessible to assess the frequency in which these activities were conducted. ²⁵

1.1.2 Antimicrobial control

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

Mozambique has a national legislation in place requiring prescriptions for antibiotic use for humans. However, there is evidence of gaps in enforcement.

Pursuant to Article 34 of Law No. 12 of 8 September 2017 (Law on Medicines, Vaccines, and Other Biological Products for Human Use), medicines, vaccines, and other health and biological products may only be sold and distributed to the public with a valid prescription. ²⁶ Antibiotics are required to be prescribed by a doctor. ²⁷

Under Article 40, Section 1, Subsection (g), of Ministerial Diploma of the Ministry of Health No. 20 of 9 February 2022, the National Regulatory Medicine Authority (ANARME, Autoridade Nacional Reguladora de Medicamento) is responsible for maintaining and updating the List of Medicines Not Subject to Medical Prescription. ²⁸

However, a 2017 study published by the City Council of Maputo and titled "Informal Sales of Medicine in Maputo: Causes and Consequences for Public Health" revealed that 54% of consumers reported acquiring medicines without the required prescription. ²⁹ ³⁰

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 0

Mozambique does not have a national regulation in place requiring prescriptions for antibiotic use for animals.

According to a July 2015 document published by the Center for Disease Dynamics, Economics & Policy (CDDEP) and the Ministry of Health of Mozambique, “No pharmacovigilance system for veterinary products, including antibiotics, is currently in place in the country, and there is a clear need to monitor the use of antibiotics both in animal production and in the clinical treatment of companion animals”. ³¹ The document also highlighted that “many private companies sell antibiotics for animal use, and anyone can purchase these antibiotics without a prescription. More than half of the available antibiotics are marketed in various combinations, including with other active biological substances”. ³²

Article 104 of Decree No. 26 of 17 August 2009 (Animal Health Regulation) states that the use of serums, vaccines, allergens, and drugs intended for animals is subject to authorization, supervision, and control by the Veterinary Authority. Their administration may also be subject to specific regulations established by the Veterinary Authority. ³³ The Veterinary Authority of Mozambique is the National Veterinary Directorate, under the purview of the Ministry of Agriculture, the Environment and Fisheries (MAAP), as per Article 3, Section b, Subsection (v), of Presidential Decree No. 5 of 6 February 2025. ³⁴ ³⁵ However, there is no specific mention of antibiotics. ³⁶ ³⁷

1.2 Zoonotic disease

1.2.1 National planning for zoonotic diseases/pathogens

1.2.1a Laws/plans on zoonotic disease

Score: 100

Mozambique has a national legislation on zoonotic diseases prioritization, detection and reporting.

Decree No. 26 of 17 August 2009 (Animal Health Regulation) establishes the regulatory framework for disease surveillance and the control of zoonotic diseases. ³⁸ The regulation covers various aspects, including the importation, circulation, and transit of animals; obligations related to animal transport; border control measures; veterinary inspection protocols; quarantine periods for zoonotic diseases; the prohibition of the circulation of sick animals; procedures to be followed in cases of suspected disease; disinfestation measures; and other related provisions. ³⁹

Pursuant to Article 21, Section 4, the Veterinary Authority may deny the importation of animals, products, and byproducts if it suspects that they are infected with zoonotic diseases listed by the World Organization for Animal Health (WOAH), with a new disease, or with an unknown disease. ⁴⁰ Article 25 further establishes that if, upon the arrival of a vehicle at a port of entry, one or more animals are suspected of carrying any of the diseases listed by the WOAH, the Veterinary Authority may prevent their entry or apply one of the following measures at the owner’s expense: (i) sanitary slaughter with sterilization or destruction of the meat in an appropriate facility, without compensation; (ii) quarantine of the animals near the port of entry; (iii) unloading and destruction of bedding, feed, and all potentially contaminated materials; and (iv) cleaning and disinfection of the vehicle, equipment, and any materials used during the operations. ⁴¹

Moreover, article 78 establishes that any individual or company must notify the Veterinary Authority in the event of any abnormality in the health status of animals that may indicate the presence of a disease listed in annexes 1 and 2. ⁴² Those particularly obligated to provide such notification include animal owners, as well as veterinarians or livestock technicians who suspect the existence of these diseases. ⁴³

The list of priority diseases includes brucellosis, foot-and-mouth disease, rabies, rinderpest, Rift Valley fever, trichinellosis, West Nile fever, bovine tuberculosis, enzootic bovine leukosis, lumpy skin disease, trichomoniasis, trypanosomosis, salmonellosis, mange, sheep and goat pox, equine plague, equine infectious anemia, equine influenza, African swine fever, avian mycoplasmosis, avian infectious bronchitis, Newcastle disease, avian influenza, among others. ⁴⁴

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 0

Mozambique does not have a national legislation which includes measures for risk identification and reduction for zoonotic disease spillover events from animals to humans.

Decree No. 26 of 17 August 2009 (Animal Health Regulation) establishes the regulatory framework for disease surveillance and the control of zoonotic diseases. ⁴⁵ The Animal Health Regulation includes measures for risk identification, such as veterinary inspection protocols, sanitary certificate requirements for animal exports, mandatory individual identification and registration of livestock in Mozambique (including name of Province, district and place, proprietorship details, date of birth, sex and breed of the animals, and other measures), prohibition of circulation of sick animals, procedures to be followed in cases of suspected diseases, disinfestation measures, and other related measures. ⁴⁶ Nevertheless, there is no specific mention of spillover events. ⁴⁷

There is no evidence of such legislation on the official websites of the Ministry of Health (MISAU), the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique), or the Ministry of Agriculture, the Environment, and Fisheries. ⁴⁸ ⁴⁹ ⁵⁰ ⁵¹

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 100

Mozambique has a program that accounts for the surveillance and control of multiple zoonotic pathogens of public health concern.

The National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), under its Scientific Strategic Program 2016–2025, has designated the Vector-Transmitted, Neglected, and Zoonotic Diseases Program (PVZ, Programa de Doenças Transmitidas por Vectores, Negligenciadas e Zoonóticas) for the same period as a strategic priority. ⁵² The PVZ is designed to generate knowledge and strengthen surveillance and diagnostic systems to support evidence-based decision-making for the prevention, treatment, and control of neglected diseases. It also aims to improve the prediction, early detection, and rapid response to zoonotic and emerging diseases. ⁵³ The program places particular emphasis on neglected tropical diseases, zoonotic diseases, and emerging infections, and includes initiatives to build diagnostic capacity within the National Health Service for monitoring and evaluating programmatic interventions focused on the control of zoonoses. ⁵⁴ Zoonotic pathogens of concern under the program include those linked to dengue, chikungunya, yellow fever, and the Zika virus. ⁵⁵

Moreover, the Ministry of Agriculture, the Environment, and Fisheries (MAAP) has an annual vaccination calendar for animals, including cattle, cats, dogs and chicken. ⁵⁶ It includes foot-and-mouth disease, brucellosis, Newcastle disease, rabies, and others. ⁵⁷

Decree No. 26 of 17 August 2009 (Animal Health Regulation) establishes the regulatory framework for disease surveillance and the control of zoonotic diseases. ⁵⁸ However, it does not specify diseases in the document. ⁵⁹

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 0

There is insufficient evidence that Mozambique has a department, agency, or similar unit functioning as a multi-sectoral co-ordinating mechanism dedicated to zoonotic diseases that functions across ministries.

The Veterinary Authority of Mozambique is the National Veterinary Directorate (DINAV), under the purview of the Ministry of Agriculture, the Environment and Fisheries (MAAP), as per Article 3, Section b, Subsection (v), of Presidential Decree No. 5 of 6 February 2025. ⁶⁰ ⁶¹ However, there is no mention that it functions across ministries. ⁶² ⁶³ DINAV is responsible for ensuring the creation of a favorable environment for the development of livestock production and marketing, with emphasis on the definition and implementation of policies, strategies, programs and legislation. In this context, within the scope of its responsibilities, DINAV regularly holds annual meetings to plan and assess performance in the livestock subsector, in coordination with the Provincial Livestock Departments, in the presence of some MAAP partners and institutions. ⁶⁴

According to the Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016), the focal point to provide veterinary reports for the World Organization for Animal Health (WOAH) is the National Veterinary Directorate. ⁶⁵ However, there is no mention it functions across ministries. ⁶⁶

There is no mention of such dedicated unit on the official websites of MAAP. ⁶⁷

1.2.1e Presence of One Health strategic plan

Score: 0

Mozambique does not have a One Health strategic plan in place, although it is in the process of developing one. In 2018, representatives from Mozambique’s human, animal, and environmental sectors from government, universities, research institutions and partners used US CDC’s OHZDP Process to prioritize endemic and emerging zoonotic diseases of greatest national concern and develop recommendations and key interventions needed to advance One Health in Mozambique. After the OHZDP workshop, Mozambique developed an initial draft of a One Health Strategic Plan titled “Mozambique One Health Strategic Plan, 2024-2029”. This strategic plan will guide the Government of Mozambique in strengthening the national capacity to prevent, detect, and respond to zoonotic diseases, Antimicrobial Resistance, Food security, Water Hygiene and Sanitation. The draft is under review by the relevant ministries and stakeholders. ⁶⁸

1.2.2 Surveillance systems for zoonotic diseases/pathogens

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 0

There is no evidence Mozambique has a national mechanism (either voluntary or mandatory) for owners of livestock to conduct and report on disease surveillance to a central government agency.

In accordance with Article 78, Section 2, of Decree No. 26 of 17 August 2009 (Animal Health Regulation), livestock owners are required to report to public health authorities any confirmed or suspected cases of infectious diseases in livestock. ⁶⁹ This notification may be made either in writing or orally. ⁷⁰ Pursuant to Article 80, in the event of confirmed or suspected infectious disease, livestock owners must report to the Veterinary Authority and take immediate action, including isolating the affected animals, suspending their movement and the use of their products, byproducts, and carcasses, preventing the opening of carcasses and ensuring their burial or incineration (unless otherwise instructed within twenty-four hours) and disinfecting pens, tools, equipment, and all materials used in the handling or transportation of those animals. ⁷¹ However, there is no indication on the website of the Ministry of Agriculture, the Environment, and Fisheries (MAAP) regarding how this reporting process is conducted or whether it is operational at the national level. ⁷²

According to the Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016), "in animal health, the diseases [with mandatory reporting] are tuberculosis, rabies, brucellosis, and cysticercosis, where reporting is on a monthly basis". ⁷³ However, "In animal health, under-reporting of zoonosis in the country represents a serious concern as veterinary and human surveillance systems are weak and mostly passive due to the involvement of slaughterhouses and large-scale farmers". ⁷⁴

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is no evidence that the Mozambican legal framework safeguards the confidentiality of information generated through surveillance activities for animals or animal owners.

The Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016) does not mention safeguards for information confidentiality. ⁷⁸ There is no evidence of such requirements on the official website of the Ministry of Agriculture, the Environment, and Fisheries (MAAP) either. ⁷⁹

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

Mozambique does not conduct surveillance of zoonotic diseases in wildlife, poultry and livestock. It is reliant on notifications from individuals and animal owners, and there is no evidence that the surveillance actions are conducted regularly.

Pursuant to Article 87, Sections 1 and 2, of Decree No. 26 of 17 August 2009 (Animal Health Regulation), in areas classified as “suspected zones” or “infected zones,” it is mandatory to subject animals that are sick, suspected of being sick, or at risk of contracting a notifiable disease to diagnostic testing, as well as to prophylactic and therapeutic measures determined by the Veterinary Authority. In addition, in designated “surveillance zones,” animals must undergo inspection and, if necessary, be subjected to the same types of preventive or therapeutic actions as ordered by the Veterinary Authority. ⁸⁰

The Animal Health Regulation, in Article 99, states that the Veterinary Authority of Mozambique may propose to the government the organised culling or restriction of movement of wild animals, even if they are located in parks, reserves, game farms, or private properties, provided that such action is necessary to (i) conduct disease investigations in order to implement appropriate sanitary measures; (ii) ensure the protection of the human and animal population from diseases for which wild animals may act as carriers or reservoirs; (iii) establish depopulated buffer zones free of wild animals; (iv) control or eradicate diseases; and (v) prevent contact between wild and domestic animals through the construction of fences. ⁸¹ Additionally, Article 100 states that any citizen or entity is obliged to report to the Veterinary or Administrative Authority in the nearest jurisdiction any changes observed in the health status of wild animals or the presence of dead wild animals. ⁸² For this purpose, Article 101 guarantees that the Veterinary Authority shall have free access to all locations where wild animals are confined, for the purpose of inspection, supervision, research, and disease surveillance in those areas. ⁸³ However, there is no evidence of recurrent surveillance, and it is mostly reliant on notifications from individuals.

In 2012, Ministry of Health in collaboration with Faculty of Veterinary from Eduardo Mondlane University and Biotechnology Center established the first one health sentinel site to conduct research and surveillance in the interface between wildlife and humans. ⁸⁴ The One Health sentinel surveillance site was established in Caia District, a rural area situated in Zambeze valley in the central part of the country, which was selected because of (i) intense contact between humans and wildlife, (ii) high vulnerability for flooding, (iii) abundance of domestic animals such as cattle, pigs and poultry, and also abundance of breeding places for mosquitoes. The one health sentinel surveillance in Caia comprised three key pillars, (i) surveillance of zoonotic diseases in febrile patients attended at the local district hospital, (ii) surveillance of zoonotic diseases in cattle, pigs, poultry and micro mammals (bats and rodents) and (iii) entomologic investigation mostly in mosquitoes and ticks. ⁸⁵ However, there is no evidence this was conducted nationwide or regularly, and according to the Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016), a One Health approach for disease prevention, control, and response occurs mostly on an ad-hoc basis whenever there is a serious health threat posed by a zoonotic disease. ⁸⁶ ⁸⁷

The Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016) states that routine surveillance systems for five or more zoonotic diseases are in place. ⁸⁸ There are weekly, monthly, and annual epidemiological bulletins report on diseases of mandatory notification, and for zoonotic diseases it includes tuberculosis, rabies, brucellosis, and cysticercosis. ⁸⁹ In addition, the Ministry of Agriculture, the Environment and Fisheries has a laboratory for diagnosis of zoonotic diseases in animals, although with limited capacity, focusing on rabies, brucellosis, Rift Valley Fever, tuberculosis, and influenza. ⁹⁰ In 2024, the Central Veterinary Laboratory (DCA) of the Agrarian Research Institute of Mozambique (IIAM) announced capacity to provide diagnoses for Avian influenza for poultry in the country. ⁹¹

However, the JEE states that "in animal health, under-reporting of zoonosis in the country represents a serious concern as veterinary and human surveillance systems are weak and mostly passive due to the involvement of slaughterhouses and large-scale farmers. Low levels of awareness on zoonotic threats at programmatic and community levels exacerbates the under-reporting". ⁹²

1.2.3 International reporting of animal disease outbreaks

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

There is publicly available evidence of a mechanism for Mozambique to report notifiable diseases to the World Organisation for Animal Health (WOAH).

Mozambique is a member of the WOAH. ⁹³ According to the Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016), Mozambique regularly reports to regional and international bodies, including the WOAH. ⁹⁴ Moreover, a WOAH focal point has been designated in the Department of Veterinary Services and veterinary services are reported to WOAH through the Animal Health Information System. ⁹⁵

In 2023, Mozambique reported to the WOAH on an H7 avian influenza outbreak among poultry on a laying hen farm. ⁹⁶

1.2.4 Animal health workforce

1.2.4a Number of veterinarians per 100,000 people

Score: 1.71

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 22.07

1.2.5 Private sector and zoonotic disease

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 0

There is no evidence Mozambique has a national plan on zoonotic disease or other legislation, regulations, or plans that include mechanisms for working with the private sector in controlling or responding to zoonoses.

The National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), under its Scientific Strategic Program 2016–2025, has designated the Vector-Transmitted, Neglected, and Zoonotic Diseases Program (PVZ, Programa de Doenças Transmitidas por Vectores, Negligenciadas e Zoonóticas) for the same period as a strategic priority. ⁹⁷ The PVZ is designed to generate knowledge and strengthen surveillance and diagnostic systems to support evidence-based decision-making for the prevention, treatment, and control of neglected diseases. It also aims to improve the prediction, early detection, and rapid response to zoonotic and emerging diseases. ⁹⁸ The program places particular emphasis on neglected tropical diseases, zoonotic diseases, and emerging infections, and includes initiatives to build diagnostic capacity within the National Health Service for monitoring and evaluating programmatic interventions focused on the control of zoonoses. ⁹⁹ Zoonotic pathogens of concern under the program include those linked to dengue, chikungunya, yellow fever, and the Zika virus. ¹⁰⁰

For the implementation of PVZ, ISN has partnership with the Tropical Medicine and Hygiene Institute (IHMT), from the NOVA University of Lisbon (UNL) with supervision from the Portuguese Ministry of Education and Science, as well as with the Southern African Centre for Infectious Disease Surveillance (SACIDS). ¹⁰¹ ¹⁰² Nevertheless, neither UNL nor SACIDS are private institutions, and there is no reference to partnerships with the private sector in controlling or responding to zoonoses. ¹⁰³

The National Action Plan Against Antimicrobial Resistance (AMR Plan, Plano Nacional de Ação Contra a Resistência Antimicrobiana 2019–2023) sets forth goals to institutionalize effective antibiotic management systems at the national, provincial, and institutional levels, across both the public and private sectors, using the integrated "One Health" approach. ¹⁰⁴ In addition, the AMR Plan identifies private associations as key stakeholders, including the Mozambican Veterinary Association, Mozambican Farmers Association, Private Sector Veterinary Association, and Mozambican Breeders Association. ¹⁰⁵ Members of the Working Group on Antimicrobial Resistance include private sector representatives, such as researchers and other partners. ¹⁰⁶ However, there plan is outdated, and the cooperation with the private sector is not detailed. ¹⁰⁷

There is no evidence that it has been updated on the official websites of the Ministry of Health (MISAU), INIS, or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ¹⁰⁸ ¹⁰⁹ ¹¹⁰

1.3 Biosecurity

1.3.1 Whole-of-government biosecurity systems

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

Mozambique does not have in place a record, updated within the past five years, of the facilities in which especially dangerous pathogens and toxins are stored or processed, including details on inventories and inventory management systems of those facilities.

The Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016) identified that "a whole-of-government, national biosafety and biosecurity system is not fully in place to ensure that especially dangerous biological pathogens and toxins are identified, held, secured, and monitored in a minimal number of facilities according to best practices". ¹¹¹ It also recommended the country to develop an inventory of existing dangerous biological pathogens and toxins presents in the country, as well as guidelines and procedures for the handling, management and storage of highly infectious materials. ¹¹² It also underscored that "a national inventory of dangerous biological pathogens and toxins should be conducted", as well as "there is a need to identify and further consolidate a small number of facilities with the capacity to hold, store, and manage dangerous biological pathogens and toxins". ¹¹³

There is no evidence that such record of the facilities has been created on the official websites of the Agrarian Research Institute of Mozambique (IIAM), the Ministry of Health, the National Health Institute of Mozambique (INS), or the Ministry of Agriculture, the Environment, and Fisheries. ¹¹⁴ ¹¹⁵ ¹¹⁶

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 50

Mozambique has regulations in place related to biosecurity. However, they do not address requirements such as physical containment, operation practices, failure reporting systems, and cybersecurity of facilities in which especially dangerous pathogens and toxins are stored or processed.

Pursuant to Article 14, Section (5), of Law No. 3 of 10 February 2022, which sets forth provisions for disease control and prevention, employers are required to implement measures for the promotion, prevention, and control of diseases, including facilitating periodic medical examinations for their employees and the systematic monitoring of those exposed to public health risks or hazards. ¹¹⁷ However, there is no mention of requirements related to physical containment, operation practices, failure reporting systems, or cybersecurity of facilities in which especially dangerous pathogens and toxins are stored or processed. ¹¹⁸

In addition, Decree No. 8 of 18 February 2003, which approved the Biomedical Waste Management Regulation, establishes that all health facilities, research institutes, or companies that manage biomedical waste must develop a biomedical waste management plan, in accordance with Article 5, Section (1). ¹¹⁹ This plan must include provisions related to the storage and transportation of biomedical waste, as well as the identification of the hazards posed by such waste. ¹²⁰ According to Article 6, Section (d), those who handle biomedical waste must ensure the protection of all workers involved, particularly against diseases resulting from exposure to biomedical waste. ¹²¹ Pursuant to article 9, infectious waste must be identified using the color yellow, and segregated in yellow plastic bags with a label reading “infectious waste.” ¹²²

Moreover, article 18 establishes the methods for final disposal of infectious waste, listed in order of preference: (i) autoclave sterilization, followed by shredding and landfilling of inert material; (ii) high-temperature incineration; (iii) chemical sterilization followed by landfilling; (iv) low-temperature incineration followed by landfilling of the residues; and (v) disposal in a sanitary landfill under technical supervision. ¹²³ However, these regulations apply specifically to medical waste and do not address facilities that store or process especially dangerous pathogens and toxins, nor do they cover pathogens themselves. ¹²⁴

The Biosecurity and Bioprotection Handbook (2022), published by the National Health Institute (INS), includes guidelines related to physical containment and operational practices, such as the use of disposable rubber gloves, cryogenic gloves, N95 masks, face shields, laboratory safety goggles, hair protection caps, long-sleeved gowns with elastic cuffs, plastic aprons, closed-toe shoes, coveralls, among others. ¹²⁵ It also provides guidance on the use of collective protective equipment, including biological safety cabinets, emergency showers and eyewash stations, autoclaves, automatic pipettors, and similar equipment. ¹²⁶ Nevertheless, the handbook does not include guidelines related to failure reporting systems or the cybersecurity of facilities that store or process especially dangerous pathogens and toxins. ¹²⁷ Furthermore, these guidelines are not part of the formal legal framework, as their provisions have not been established through legislation. ¹²⁸

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

Mozambique does not have an established agency responsible for the enforcement of biosecurity legislation and regulations.

According to Decree No. 57 of 2 November 2017, which redefined the structure and responsibilities of the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), the Institutional Biosecurity Committee (CIB-INS) was established within the INS. Pursuant to Article 5, Section (k), the committee is responsible for ensuring all aspects of biosecurity related to the operation of reference laboratories. ¹²⁹

Pursuant to Article 16, Sections 3 and 6, of Resolution No. 17 of 1 June 2018, the CIB-INS convenes once monthly, and it is tasked with ensuring the development, implementation and continuous enhancement of biosecurity and bioprotection programs of the INS. ¹³⁰ The Biosecurity and Bioprotection Handbook (2022), published by the INS, states that CIB-INS is tasked with enforcing biosecurity measures in INS laboratories. ¹³¹ In any case, there is no evidence CIB-INS is responsible for enforcing biosecurity regulations outside of the scope of INS. ¹³² ¹³³ ¹³⁴

The National Action Plan Against Antimicrobial Resistance (AMR Plan, Plano Nacional de Ação Contra a Resistência Antimicrobiana 2019–2023) lists the Ministry of Agriculture, the Environment and Fisheries (MAAP), formerly the Ministry of Agriculture and Food Safety (MASA), through the National Veterinary Directorate, is responsible for enhancing standardization of biosecurity regulations. ¹³⁵ However, there is no mention of enforcement of biosecurity legislation. ¹³⁶

The Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016) underscores that a "whole-of-government, national biosafety and biosecurity system is not fully in place to ensure that especially dangerous biological pathogens and toxins are identified, held, secured, and monitored in a minimal number of facilities according to best practices". ¹³⁷ It also points out that "despite the establishment of the Inter-Institutional Biosafety Group (GIIBS), there is a need to further operationalize at national, provincial and local levels", and that the "development of additional specific biosecurity and biosafety legislation is needed, as well as the monitoring and enforcement of existent laws regarding biosafety of GMOs". ¹³⁸

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

There is no public evidence Mozambique has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities.

The Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016) underscores that a "whole-of-government, national biosafety and biosecurity system is not fully in place to ensure that especially dangerous biological pathogens and toxins are identified, held, secured, and monitored in a minimal number of facilities according to best practices". ¹³⁹ It also added that "there is a need to identify and further consolidate a small number of facilities with the capacity to hold, store, and manage dangerous biological pathogens and toxins". ¹⁴⁰

There is no evidence of such actions on the official websites of the Ministry of Health (MISAU), the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), the Ministry of Agriculture, the Environment, and Fisheries (MAAP), or the Ministry of National Defense. ¹⁴¹ ¹⁴² ¹⁴³ ¹⁴⁴

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 100

There is public evidence of in-country capacity in Mozambique to conduct Polymerase Chain Reaction (PCR)-based diagnostic testing for Ebola, which could preclude culturing a live pathogen.

In 2018, the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde) inaugurated laboratories with capacity to conduct PCR-based diagnostic testing for Ebola. ¹⁴⁵ In 2020 and 2022, the World Health Organization (WHO) donated a RT-PCR thermocycler and three PCR equipment for the INS. ¹⁴⁶ ¹⁴⁷

1.3.2 Biosecurity training and practices

1.3.2a Biosecurity training using a standardised, required approach

Score: 33.33

Mozambique provides biosecurity and biosafety training for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential. Even though there is a train-the-trainer program and the Global Biorisk Management Curriculum (GBRMC) is used, there is evidence that it is only provided on an ad hoc basis. There is no evidence that participants are required to recertify.

In 2023, the National Health Institute (INS), through its Institutional Biosecurity Committee (CIB-INS), implemented the first Biosecurity and Bioprotection Train-the-Trainer Program using the GBRMC model, which was composed of a five-day training conducted by senior experts from the INS, in collaboration with international facilitators from the East, Central and Southern Africa Health Community (ECSA-HC), and included 24 participants from 19 public institutions of the Government of Mozambique. ¹⁴⁸ The participants came from sectors involved in research, education, regulation, funding, and service delivery in human health (both civil and military), animal health, plant health, and environmental health. ¹⁴⁹ The training programme consisted of a theoretical and practical package covering topics such as: Introduction to Biosecurity and Bioprotection; Policy and Regulation in Biological Risk Management; Laboratory Bioprotection; Field Biosafety and Bioprotection; the AMP Model for Biological Risk Management; Biocontainment and Laboratory Infrastructure Design; Biological Waste Management; Packaging and Transport of Infectious Substances; Incident Management; and Occupational Health and Safety. ¹⁵⁰

In September 2020, the INS conducted biosecurity and bioprotection training for higher education institutions at Lúrio University, aimed at educating academic personnel on good practices, particularly in relation to the COVID-19 pandemic and reopening measures. ¹⁵¹ ¹⁵² In the same year, the INS also provided training to staff of the National Institute of Statistics (INE) on prevention and personal protection measures against COVID-19. ¹⁵³

Law No. 3 of 10 February 2022, which sets forth provisions for disease control and prevention does not include provisions on training on personnel. ¹⁵⁴ Likewise, Article 4, Section (2), Subsection (f), of Decree No. 8 of 18 February 2003, which approved the Biomedical Waste Management Regulation, sets that the Ministry of Health must conduct training related to biomedical waste management; however, there is no mention of dangerous pathogens, toxins, or biological materials with pandemic potential. ¹⁵⁵

The Biosecurity and Bioprotection Handbook (2022), published by INS, states that all professionals within INS must receive specific training on the use of personal protective equipment. It also mandates that staff operating autoclaves must be trained in decontamination procedures. ¹⁵⁶ In 2020, INS provided training to all personnel handling samples, with a particular focus on transportation guidelines, data entry procedures, and COVID-19 prevention measures. ¹⁵⁷ However, the handbook does not establish provisions regarding the frequency of such training, the implementation of train-the-trainer programs, the adoption of a standardised curriculum, or the requirement for recertification every five years. ¹⁵⁸

1.3.3 Personnel vetting: regulating access to sensitive locations

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is no evidence Mozambican regulations or licensing conditions specify that security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential are subject to the drug testing, background checks, and psychological or mental fitness checks.

The Biosecurity and Bioprotection Handbook (2022), published by the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), established special requirement for professionals within the INS dealing with dangerous pathogens, toxins, or biological materials, such as regular testing for contaminants (6.3.b). ¹⁵⁹ However, there is no mention of drug testing, background checks, or psychological or mental fitness checks. ¹⁶⁰

Pursuant to Article 14, Section 5, of Law No. 3 of 10 February 2022, which sets forth provisions for disease control and prevention, employers are required to implement measures for the promotion, prevention, and control of diseases, including facilitating periodic medical examinations for their employees and the systematic monitoring of those exposed to public health risks or hazards. ¹⁶¹ Moreover, while Chapter VI addresses Occupational Health, it does not include any provisions requiring specific health screenings for individuals with access to hazardous pathogens. ¹⁶²

The World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016) does not underscore any checks either. ¹⁶³

There is no evidence of such regulations or licensing conditions on the official websites of the Ministry of Health (MISAU), the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), the Ministry of Agriculture, the Environment, and Fisheries (MAAP), or the Ministry of National Defense. ¹⁶⁴ ¹⁶⁵ ¹⁶⁶ ¹⁶⁷

1.3.4 Transportation security

1.3.4a National transport regulations for Category A and B infectious substances

Score: 0

Mozambique does not have national regulations on the safe and secure transport of infectious substances, specifically including Categories A and B.

The Biosecurity and Bioprotection Handbook (2022), published by the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), states that the transport of biological samples or infectious substances within the INS follows the guidelines and recommendations of the international regulations for the transport of infectious substances issued by the World Health Organization (WHO), the International Civil Aviation Organization (ICAO), or the International Air Transport Association (IATA), as approved and applicable on a biennial basis. ¹⁶⁸

These guidelines establish specific procedures for both inter-laboratory and intra-laboratory transport, including the use of a triple packaging system, durable secondary containers, prohibition of direct contact with body parts, closed containment systems, use of personal protective equipment (PPE), among other safety measures. ¹⁶⁹ However, there is no evidence of national regulations specific to the transport of infectious substances, only the adoption of international standards. ¹⁷⁰

There is no further evidence of such regulations on the official websites of the Ministry of Health (MISAU), the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ¹⁷¹ ¹⁷² ¹⁷³

1.3.5 Cross-border transfer and end-user screening

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

Mozambique has legislation in place to oversee the cross-border transfer of dangerous pathogens, toxins, and pathogens with pandemic potential. However, there is no mention of end-user screening related to these pathogens.

Pursuant to Article 29, Section 1, of Decree No. 26 of 17 August 2009 (Animal Health Regulation), the importation of pathogens requires special authorization and is subject to oversight by both the Veterinary Authority and the Mozambique Tax Authority (ATM, Autoridade Tributária de Moçambique), which is responsible for customs control. ¹⁷⁴ Entry of such materials must comply with packaging requirements designed to prevent external contamination, in accordance with standards established by the World Health Organization (WHO), the International Civil Aviation Organization (ICAO), and the International Air Transport Association (IATA). Transport must also be carried out by qualified personnel, as stipulated in Article 29, Sections 5. ¹⁷⁵ However, there is no mention of any screening or vetting procedures for end users. ¹⁷⁶

Pursuant to Article 10, Subsection (f), of Law No. 3 of 10 February 2022, which sets forth provisions for disease control and prevention, health surveillance considers health problems related to the international transit of individuals and goods. ¹⁷⁷ On that regard, Article 23 states that health authorities can regulate the entry or exit of any products that can pose threats to public health. ¹⁷⁸ However, there are no specific measures related to dangerous pathogens, toxins, and pathogens with pandemic potential. ¹⁷⁹

The National Action Plan Against Antimicrobial Resistance (AMR Plan, Plano Nacional de Acção Contra a Resistência Antimicrobiana 2019-2023) does not mention such regulations or requirements. ¹⁸⁰ The Biosecurity and Bioprotection Handbook (2022), published by the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), does not mention cross-border transportation. ¹⁸¹

The World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016) underscores that "there is a lack of procedures and plans for public health incident management (i.e. outbreak investigation and response, cross-border control of disease)", and that "the system for transport of specimens is adequate and mainly used for confirmation of outbreaks" referring to transport between laboratories. ¹⁸² There is no mention of cross-border transportation security measures. ¹⁸³

1.4 Biosafety

1.4.1 Whole-of-government biosafety systems

1.4.1a Biosafety laws/regulations

Score: 0

Mozambique does not have national biosafety legislation and regulations.

Law No. 3 of 10 February 2022 sets forth provisions for disease control, prevention, and the protection of human health. ¹⁸⁸ Decree No. 71 of 28 November 2014 presents biosafety regulations concerning genetically modified organisms (GMOs). ¹⁸⁹ In addition, Mozambique is a signatory to the Cartagena Protocol on Biosafety. ¹⁹⁰

Nevertheless, according to the Biosecurity and Bioprotection Handbook (2022), published by the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), “The country still lacks a comprehensive legal framework specifically addressing biosecurity and bioprotection in human health. However, there is some general legislation (…) which reflects the national and local commitment to advancing biosecurity and bioprotection efforts toward global health security.” ¹⁹¹

The World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016) states that "Mozambique has a biological risk management system, laws related to biosafety and biosecurity issues, such as biomedical waste, animal health, and genetically modified organisms. Mozambique also has a National Biosafety Authority, and national guidelines for biosafety. However, a whole-of-government, national biosafety and biosecurity system is not fully in place – national biosafety and biosecurity legislation, laboratory licensing, and pathogen control measures are not completely in place". ¹⁹²

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

There is no evidence Mozambique has an agency responsible for the enforcement of biosafety legislation and regulations.

Pursuant to Article 16, Sections 3 and 6, of Resolution No. 17 of 1 June 2018, the CIB-INS convenes once monthly, and it is tasked with ensuring the development, implementation and continuous enhancement of biosecurity and bioprotection programs of the INS. ¹⁹⁴ The Biosecurity and Bioprotection Handbook (2022), published by the INS, states that CIB-INS is tasked with enforcing biosecurity measures in INS laboratories. ¹⁹⁵ In any case, there is no evidence CIB-INS is responsible for enforcing biosecurity regulations outside of the scope of INS. ¹⁹⁶ ¹⁹⁷ ¹⁹⁸

The World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016) underscores that "Mozambique has a National Biosafety Authority, and national guidelines for biosafety. However, a whole-of-government, national biosafety and biosecurity system is not fully in place – national biosafety and biosecurity legislation, laboratory licensing, and pathogen control measures are not completely in place". Additionally, it recommends as a priority action, to "ensure operationalization of the inter-institutional biosafety group and the institutional biosafety committee at the national level".

1.4.2 Biosafety training and practices

1.4.2a Biosafety training using a standardised, required approach

Score: 33.33

In 2023, the National Health Institute (INS), through its Institutional Biosecurity Committee (CIB-INS), implemented the first Biosecurity and Bioprotection Train-the-Trainer Program using the GBRMC model, which was composed of a five-day training conducted by senior experts from the INS, in collaboration with international facilitators from the East, Central and Southern Africa Health Community (ECSA-HC), and included 24 participants from 19 public institutions of the Government of Mozambique. ¹⁹⁹ The participants came from sectors involved in research, education, regulation, funding, and service delivery in human health (both civil and military), animal health, plant health, and environmental health. ²⁰⁰ The training programme consisted of a theoretical and practical package covering topics such as: Introduction to Biosecurity and Bioprotection; Policy and Regulation in Biological Risk Management; Laboratory Bioprotection; Field Biosafety and Bioprotection; the AMP Model for Biological Risk Management; Biocontainment and Laboratory Infrastructure Design; Biological Waste Management; Packaging and Transport of Infectious Substances; Incident Management; and Occupational Health and Safety. ²⁰¹

In September 2020, the INS conducted biosecurity and bioprotection training for higher education institutions at Lúrio University, aimed at educating academic personnel on good practices, particularly in relation to the COVID-19 pandemic and reopening measures. ²⁰² ²⁰³ In the same year, the INS also provided training to staff of the National Institute of Statistics (INE) on prevention and personal protection measures against COVID-19. ²⁰⁴

Law No. 3 of 10 February 2022, which sets forth provisions for disease control and prevention does not include provisions on training on personnel. ²⁰⁵ Likewise, Article 4, Section (2), Subsection (f), of Decree No. 8 of 18 February 2003, which approved the Biomedical Waste Management Regulation, sets that the Ministry of Health must conduct training related to biomedical waste management; however, there is no mention of dangerous pathogens, toxins, or biological materials with pandemic potential. ²⁰⁶

The Biosecurity and Bioprotection Handbook (2022), published by INS, states that all professionals within INS must receive specific training on the use of personal protective equipment. It also mandates that staff operating autoclaves must be trained in decontamination procedures. ²⁰⁷ In 2020, INS provided training to all personnel handling samples, with a particular focus on transportation guidelines, data entry procedures, and COVID-19 prevention measures. ²⁰⁸ However, the handbook does not establish provisions regarding the frequency of such training, the implementation of train-the-trainer programs, the adoption of a standardised curriculum, or the requirement for recertification every five years. ²⁰⁹

1.5 Dual-use research and culture of responsible science

1.5.1 Oversight of dual-use research

1.5.1a Evidence of national assessment of dual-use research

Score: 0

Mozambique has not conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential and other dual-use research.

In 2022, the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde) published its most recent available Activity Report, highlighting research activities focused on pathogens such as tuberculosis, malaria, and HIV. ²¹⁰ ²¹¹ However, the report does not reference any research involving other dangerous pathogens, toxins, or pathogens with pandemic potential. ²¹²

The INS also releases quarterly data on SARS and influenza, with the latest dating July 2024. ²¹³ ²¹⁴ Nonetheless, these reports do not provide information on specific ongoing research related to those viruses. ²¹⁵ ²¹⁶ There is no further evidence on INS's official website. ²¹⁷

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no evidence that the Mozambican legal framework requires oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research.

The Law on Human Health Research (Law No. 6 of 8 June 2023) seeks to ensure regulation of research activity related to human health in Mozambique, as per Article 5, Subsection (a). ²¹⁸ Pursuant to Article 20, Section 1, human health research is subject to oversight, which is conducted by the Multi-Institutional Human Health Research Oversight Commission (CFISH, Comissão Multi-Institucional de Fiscalização de Investigação em Saúde Humana). ²¹⁹

According to Article 9, the researcher must have the adequate academic qualifications in human health, as well as valid certification of an Ethics course. ²²⁰ The specific requirements are outlined in Article 18 of Decree No. 53 of 18 July 2024, which regulated the Law on Human Health Research. ²²¹

Moreover, CFISH must approve research in human health, as per Article 15. ²²² Additionally, the processing of biological samples requires authorized laboratories, and the researcher must prove the need for the sample, obtain authorizations, establish sample transfer agreements, and others. ²²³ According to Article 22 of Decree No. 53/2024, the use of biological samples requires ethical approval, collection by qualified personnel, disclosure of the tests, and others. ²²⁴ Nevertheless, there is no specific mention of especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research. ²²⁵ ²²⁶

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 0

There is no evidence Mozambique has an agency specifically responsible for the oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research.

According to Articles 15 and 19 of the Law on Human Health Research (Law No. 6 of 8 June 2023), the Multi-Institutional Human Health Research Oversight Commission (CFISH, Comissão Multi-Institucional de Fiscalização de Investigação em Saúde Humana) is responsible for oversight of research on human health. ²²⁷ Additionally, the National Bioethics Committee for Health (CNBS, Comité Nacional de Bioética para Saúde) must approve the use of biological samples, as per Article 22 of Decree No. 53 of 18 July 2024, which regulated the Law on Human Health Research. ²²⁸ Nevertheless, there is no specific mention of especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research. ²²⁹ ²³⁰

1.5.2 Screening requirements for providers of genetic material

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no evidence Mozambique has legislation or regulations requiring the screening of synthesized DNA (deoxyribonucleic acid) against lists of known pathogens and toxins before it is sold.

There is no mention of such requirements on the Mozambican legal framework, namely Law No. 3 of 10 February 2022, Decree No. 26 of 17 August 2009, Decree No. 71 of 28 November 2014, or Law No. 6 of 8 June 2023. ²³¹ ²³² ²³³ ²³⁴ The World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016) does not mention such requirement either. ²³⁵

On 15 April 2025, Mozambique submitted a Confidence-Building Measures report before the United Nations. ²³⁶ However, the content is not publicly available. ²³⁷

There is no evidence of such requirements on the official websites of the Ministry of Health (MISAU), the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), the Ministry of Agriculture, the Environment, and Fisheries (MAAP), or the Ministry of National Defense. ²³⁸ ²³⁹ ²⁴⁰ ²⁴¹

1.6 Immunization

1.6.1 Vaccination rates

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 100

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 100

Official foot-and-mouth (FMD) vaccination figures for livestock in Mozambique are publicly available through the OIE database.

However, the latest available data refers to the second semester of 2022. ²⁴²

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

Mozambique has a national immunization plan, which includes strategies specifically aimed at ensuring equitable distribution and overcoming geographical and socioeconomic inequalities.

In 2020, the Ministry of Health published the Comprehensive Multi-year Plan of the National Immunization Program (cMYP) 2020-2024, which covers 11 diseases, namely Tuberculosis, Diphtheria, Pertussis, Tetanus, Hepatitis B, Rotavirus diarrheal disease, haemophilus influenza type b, Pneumococcal Disease, measles, rubella, and polio. ²⁴³ The cMYP is focused increasing immunization coverage to narrow the immunization gap between rich and poor, and focuses on reducing geographical inequalities in the access and use of health services. ²⁴⁴ It includes goals to sustain 90% coverage every year, improve supply distribution using improved transport, and others. ²⁴⁵

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 100

Mozambique's national immunization plan includes measures to address vaccine hesitancy and build public trust in vaccines.

In 2020, the Ministry of Health published the Comprehensive Multi-year Plan of the National Immunization Program (cMYP) 2020-2024, which covers 11 diseases, namely Tuberculosis, Diphtheria, Pertussis, Tetanus, Hepatitis B, Rotavirus diarrheal disease, haemophilus influenza type b, Pneumococcal Disease, measles, rubella, and polio. ²⁴⁶ The cMYP includes a section on demand generation, communication, and advocacy, which outlines efforts to strengthen risk communication and social mobilization, which include the use of community health agents operating at the community level, the network of community health and co-management committees at the district level, community platforms such as religious leaders, community theatres, community health committees, community radio, and traditional healers, as well as support from partners to produce weekly Facts for Life programmes to promote immunization, vaccination campaigns, and other initiatives. ²⁴⁷

For vaccination campaigns, such as the Measles-Rubella campaign and the response to the vaccine-derived polio outbreak, various communication channels were employed to mobilise parents and caregivers. These included community radio, ICS Multimedia Mobile Units, social media platforms, social mobilisers, and religious and community leaders. ²⁴⁸

1.6.1e National advisory group for immunization strategy/plan

Score: 100

Mozambique has a national advisory group that provides technical guidance and advice on the immunization plan to the government.

The Expert Committee on Immunization (CoPI), created in 2011, is Mozambique's National Immunization Technical Advisory Group (NITAG), which advises the Ministry of Health on immunization using evidence-based policy recommendations such as introduction of new vaccines, schedule for vaccination, financing, and research priorities and strategies. ²⁴⁹ ²⁵⁰ ²⁵¹ It is comprised of 15 members appointed by the Ministry of Health for a four-year term, renewable once, from various areas of expertise, such as public health, child health and paediatrics, epidemiology, sociology, health economics, microbiology, and others – they convene every six months. ²⁵² ²⁵³ There are up to 20 permanent observers, including representatives from the World Health Organization (WHO), and the United Nations Children's Fund, which may attend meetings but cannot vote or participate in closed sessions. ²⁵⁴

1.6.1f Presence of an immunization programme for influenza

Score: 0

There is no evidence Mozambique has an immunization program for influenza.

The CDC Mozambique, established in 2000, collaborates with the Ministry of Health to strengthen the country’s core public health capabilities, including data collection and surveillance, laboratory capacity, public health workforce and institutions, and the prevention and response to health threats. ²⁵⁷ Its priority program areas include HIV, tuberculosis (TB), malaria, cholera, polio, and respiratory viruses such as influenza and COVID-19. ²⁵⁸ However, there is no mention of immunization programs related to influenza. ²⁵⁹

According to World Health Organization (WHO) data, information on the introduction status of the seasonal influenza vaccine for Mozambique is only available for 2012, when it reported that the country had not yet introduced the vaccine. ²⁶⁰ Furthermore, WHO data on influenza vaccination coverage contains no records for Mozambique. ²⁶¹

1.7 Climate change adaptation and vector transmission

1.7.1 Health system resilience

1.7.1a Strategy/plan for resilience of health system

Score: 100

Mozambique has a plan to develop a health system that is resilient to challenges that climate change and changing seasonal weather patterns pose, that includes the threat of infectious diseases.

The Strategic Plan for the Health Sector (PESS) 2020-2024, published in August 2022 by the Ministry of Health (MISAU), includes a program on environmental health with the goal of contributing to the reduction of the incidence and prevalence of diseases related to environmental health determinants. ²⁶² The measures outlined include (i) conducting door-to-door visits to assess the hygienic and sanitary conditions of communities for the control of environmental determinants (water, food, and sanitation); (ii) developing an environmental health strategy that incorporates the assessment of health risks arising from climate change and corresponding resilience mechanisms; (iii) building technical capacity (human resources and technology) for the surveillance of health determinants, including emerging infectious diseases and those resulting from climate change, as well as for carrying out sanitary inspections and monitoring water and food safety; (iv) and defining standards and procedures aimed at preventing environmentally related diseases and protecting public health, among others. ²⁶³

Early Detection

2.1 Laboratory systems strength and quality

2.1.1 Lab capacity for detecting priority diseases

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 0

The national laboratory system in Mozambique has the capacity to conduct diagnostic tests for at least 3 out of the 10 WHO-defined core tests, namely HIV, microscopy for mycobacterium tuberculosis (TB), and rapid diagnostic testing for plasmodium spp (malaria).

The National Health Institute (INS, Instituto Nacional de Saúde) laboratory system includes laboratories capable of conducting diagnostic tests for HIV, TB, and malaria. ²⁶⁴ ²⁶⁵ ²⁶⁶ ²⁶⁷ The Serology Laboratory conducts diagnostic for HIV, as well as Hepatitis B and C. ²⁶⁸ The Molecular Parasitology Laboratory is a reference laboratory for malaria, but also conducts diagnostics for lymphatic filariasis, trypanosomiasis, and schistosomiasis. ²⁶⁹ The Microbiology Laboratory conducts diagnostic for syphilis, and V. cholerae. ²⁷⁰ In addition, the Tuberculosis Laboratory conduct diagnostic on tuberculosis. ²⁷¹

The Viral Isollation Laboratory conducts surveillance and research in viral infections, including influenza, rotavirus, dengue, chikungunya, Zika virus, and yellow fever. ²⁷² However, there is no mention it conducts diagnostics for those diseases. ²⁷³

The World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016) underscores that "most health center laboratories only conduct malaria and TB smear microscopy, HIV and malaria rapid-diagnostics tests (RDT), and urinalysis". ²⁷⁴

2.1.1b Plan to conduct testing during a public health emergency

Score: 0

There is no evidence Mozambique has a national plan for conducting testing during a public health emergency, which includes considerations for testing for novel pathogens, scaling capacity, and defining goals for testing.

The Human Health Research Agenda 2024-2028 (2023) (AGISA), published by the Ministry of Health (MISAU) through the National Health Institute (INS, Instituto Nacional de Saúde), is a catalyst instrument for research in human health, particularly promoting research in priority areas of the health sector. ²⁷⁵ However, there is no mention of testing during public health emergencies. ²⁷⁶

Law No. 3 of 10 February 2022 presents measures related to public health emergencies, such as quarantine. ²⁷⁷ However, there are no considerations for testing for novel pathogens, scaling capacity, or goals for testing. ²⁷⁸

Moreover, Mozambique does not have an overarching national public health emergency response plan in place. In May 2022, MISAU, through the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde) and the National Directorate of Public Health (DNSP), a workshop to update the National Action Plan for Health Security (PNASS, Plano Nacional de Acção para Segurança Sanitária) for 2023-2027. ²⁷⁹ According to the INS, the discussions around PNASS for 2023-2027 covered multiple threat types, such as antimicrobial resistance, zoonotic diseases, and others. ²⁸⁰ However, there is no evidence that PNASS has been published on the websites of MISAU, INS or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ²⁸¹ ²⁸² ²⁸³

2.1.2 Laboratory quality systems

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 100

Mozambique has a national laboratory that serves as a reference facility which is accredited.

According to the World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016), the Ministry of Health (MISAU) has adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) and created the National Quality Improvement and Accreditation Program. ²⁸⁴ The SLMTA started with six laboratories in 2011, and it has enrolled 25 laboratories and blood banks. ²⁸⁵

The National Reference Laboratory for Tuberculosis received the ISO 15819 accreditation in 2014, whereas the Cellular Immunology Laboratory received ISO 15189 in 2016. ²⁸⁶ ²⁸⁷ In 2025, the Virology Laboratory of the National Institute of Health (INS, Instituto Nacional de Saúde) was recognized by the WHO as a National Influenza Center, which points out that the data produced by the laboratory are high-quality. ²⁸⁸

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

Mozambique has national laboratories that serve as reference facilities which are subject to external quality assurance review.

According to the World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016), "The reference laboratories participate in international external quality assurance programmes in various pathogens and some are certified and/or accredited". ²⁸⁹ Moreover, in 2025, the WHO accredited the Virology Laboratory of the National Health Institute (INS, Instituto Nacional de Saúde) as a National Influenza Center. ²⁹⁰

2.2 Laboratory supply chains

2.2.1 Specimen referral and transport system

2.2.1a Nationwide specimen transport system

Score: 0

Mozambique has a specimen transport system from the site of collection to a laboratory for testing. However, there is no evidence that the system is nationwide.

According to the World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016), the "system for transport of specimens is adequate and mainly used for confirmation of outbreaks". ²⁹¹ It also adds that the "specimen referral and transport systems are notably stronger for large, vertically funded disease programs such as HIV, TB, and malaria". ²⁹²

The Biosecurity and Bioprotection Handbook (2022), published by the National Health Institute (INS, Instituto Nacional de Saúde), states that the transport of biological samples or infectious substances within the INS follows the guidelines and recommendations of the international regulations for the transport of infectious substances issued by the World Health Organization (WHO), the International Civil Aviation Organization (ICAO), or the International Air Transport Association (IATA), as approved and applicable on a biennial basis. ²⁹³

These guidelines establish specific procedures for both inter-laboratory and intra-laboratory transport, including the use of a triple packaging system, durable secondary containers, prohibition of direct contact with body parts, closed containment systems, use of personal protective equipment (PPE), among other safety measures. ²⁹⁴ However, there is no evidence its a nationwide applicable system. ²⁹⁵

2.2.2 Laboratory cooperation and coordination

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

There is no evidence Mozambique has a plan in place to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak.

There is no evidence of such plan on the websites of the Ministry of Health (MISAU), the National Health Institute (INS) or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ²⁹⁶ ²⁹⁷ ²⁹⁸ Law No. 3 of 10 February 2022, which sets forth provisions for disease control and prevention, does not present such provisions either. ²⁹⁹

2.3 Real-time surveillance and reporting

2.3.1 Indicator and event-based surveillance and reporting systems

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

There is evidence Mozambique is conducting ongoing indicator-based surveillance (IBS) and analysis for notifiable and novel infectious diseases. However, event-based surveillance (EBS) occurs on a limited scale. However, there is no evidence that the data are being analyzed on a daily basis.

The World Health Organization's (WHO) Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Mozambique (2016) states that IBS is well established in the country, whereas EBS, including community-based surveillance, for both human and animal sectors are weak or absent. ³⁰⁰ The IBS system reports on a weekly basis on ten priority diseases, namely malaria, measles, meningitis, diarrhoea, dysentery, cholera, acute flaccid paralysis, rabies, plague, and neonatal tetanus, in the Weekly Epidemiological Bulletin (BES), and sentinel surveillance system of four syndromic diseases (febrile syndrome, respiratory syndrome, diarrheal syndrome, meningitis) in the Monthly Epidemiological Bulletin-Sentinel Post (BEM-PS). ³⁰¹ Additionally, influenza and acute respiratory infection surveillance is active through a sentinel system established in 2013 which has been adapted for COVID-19 and tracks trend, seasonality, and circulation of pathogens like influenza, RSV, and SARS-CoV-2 with real-time alerts via the National Health Institute's Alert Observation System. ³⁰²

However, EBS is not in place, in which log book to record unusual events or rumours of outbreaks does not exist at health facilities, and there is a lack of capacity for early analysis of surveillance data at district level for action. ³⁰³ There is no evidence that it is being analyzed on a daily basis. ³⁰⁴

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

In Mozambique, there is publicly available evidence of a mechanism, such as IHR focal point, for reporting notifiable diseases to the World Health Organization (WHO) within the set timeline.

According to the World Health Organization's (WHO) Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Mozambique (2016), the National IHR focal point has been established in Mozambique, and there is a plan to restructure the IHR cabinet to improve its effectiveness. ³⁰⁵ The focal point, established in 2005, has undertaken IHR training through WHO courses in Kenya (2007) and Burkina Faso (2010), and has access to WHO's Event Information System. ³⁰⁶

In May 2022, Mozambique reported to the WHO a case of wild poliovirus in the country. ³⁰⁷ In addition, the WHO has a country office in Mozambique. ³⁰⁸

2.3.2 Interoperable, interconnected, electronic real-time reporting systems

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

Mozambique operates an electronic reporting surveillance system at both the national and the sub-national level.

The Ministry of Health (MISAU) manages the Health Information System for Monitoring and Evaluation (SIS-MA), an open-source, web-based platform designed to support the collection, storage, analysis, interpretation, visualization, and dissemination of health information used to inform and monitor public health policies at the national level. ³⁰⁹ SIS-MA is intended to gather data on various aspects of health, including demographic information, health indicators, healthcare service coverage, epidemiology, and human resources in the health sector. The system is also used to generate reports, analyze data, and share information among a wide range of stakeholders, including health organizations, development partners, government agencies, and non-governmental organizations. ³¹⁰

As part of SIS-MA, MISAU operates the Epidemiological Surveillance Information System (SIVE), a dedicated module designed to collect, analyze, and interpret epidemiological data in real time to enable a rapid and effective response to disease outbreaks and facilitates the recording of data related to vaccination campaigns targeting diseases under surveillance. ³¹¹ However, neither SIS-MA nor SIVE is publicly accessible, as access requires a login and password. ³¹²

According to the World Health Organization's (WHO) Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Mozambique (2016), while paper-based surveillance system is used at the local level and predominant, at the provincial and national level, the system is electronic. ³¹³ The document also states that "paper-based reports with aggregate data from peripheral health units are entered into a computer database at district level, and then electronic aggregate reports are transmitted to the provincial level, aggregated there and then transmitted onward to Public Health Directorate at the National level at the MISAU". ³¹⁴

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 0

Mozambique has a real-time electronic reporting surveillance system, but there is no information whether the system collects ongoing or real-time laboratory data. Moreover, there is no publicly evidence it enables data to be disaggregated and analysed by age, ethnicity, and other variables.

The Ministry of Health (MISAU) manages the Health Information System for Monitoring and Evaluation (SIS-MA), an open-source, web-based platform designed to support the collection, storage, analysis, interpretation, visualization, and dissemination of health information used to inform and monitor public health policies at the national level. ³¹⁵ SIS-MA is intended to gather data on various aspects of health, including demographic information, health indicators, healthcare service coverage, epidemiology, and human resources in the health sector. The system is also used to generate reports, analyze data, and share information among a wide range of stakeholders, including health organizations, development partners, government agencies, and non-governmental organizations. ³¹⁶ However, there is no information whether it collects ongoing or real-time laboratory data. ³¹⁷

As part of SIS-MA, MISAU operates the Epidemiological Surveillance Information System (SIVE), a dedicated module designed to collect, analyze, and interpret epidemiological data in real time to enable a rapid and effective response to disease outbreaks and facilitates the recording of data related to vaccination campaigns targeting diseases under surveillance. ³¹⁸ However, neither SIS-MA nor SIVE is publicly accessible, as access requires a login and password and there is no evidence anyone can create an account. ³¹⁹

2.3.3 Wastewater surveillance

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of some wastewater and environmental surveillance (WES) activity within the country. The WHO and GPEI Q4 2025 Polio ES Bulletin lists the country as having 11 ES sites as of Q4 in 2025, although it is unclear whether these are at the national level and are ongoing.³²⁰

The Mozambique National Institute of Health (INS), in partnership with APHL under the Global Fund’s Project Stellar, piloted wastewater-based surveillance (WWBS) in Maputo. As part of this project, teams deployed Moore swabs at two urban sites to collect wastewater, which was then analyzed in the INS reference labs. This surveillance has successfully detected SARS‑CoV‑2, and there are plans to expand monitoring to four more pathogens—cholera, polio, Salmonella typhi, and influenza—as part of an integrated environmental health monitoring strategy. However, this project ran from March 2022 to June 2024.³²¹³²²

From January to November 2018, a period that immediately preceded the cVDPV outbreak in Africa, 63 wastewater samples were collected from different areas in Maputo city. This was a one-off for a research programme.³²³

2.4 Surveillance data accessibility and transparency

2.4.1 Coverage and use of electronic health records

2.4.1a Common usage of electronic health records

Score: 50

Electronic health records are not commonly in use, but there is evidence they are used in Mozambique.

According to the World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016), "Paper-based surveillance is predominant in the country. Paper-based reports with aggregate data from peripheral health units are entered into a computer database at district level, and then electronic aggregate reports are transmitted to the provincial level, aggregated there and then transmitted onward to Public Health Directorate at the National level at the Ministry of Health (MISAU)". ³²⁴

However, MISAU has been working in the transition from paper-based to electronic records for health information. ³²⁵ However, according to officials from the National Health Institute (INS, Instituto Nacional de Saúde), there is no deadline for the full transition. ³²⁶

Moreover, the Health Policy and its Strategy for Implementation, enacted through Resolution No. 13 of 16 April 2021, sets the goal of increasing the use of information and communication technologies, including through the institutionalized use and expansion of electronic records and electronic platforms for health information (Strategy 15; 1.1.15). ³²⁷

2.4.1b Public health system access to individual electronic health records

Score: 0

There is insufficient evidence that the Mozambican national public health system has access to electronic health records of individuals in their country.

As part of SIS-MA, MISAU operates the User Management Data Module (SIS-U), the hospital module that enables the recording and monitoring of individual patient data relating to hospitalisations, deaths, discharges, tuberculosis, cancer, maternal and neonatal deaths, and birth registrations. ³²⁹ However, neither SIS-MA nor SIVE is publicly accessible, as access requires a login and password and there is no evidence anyone can create an account. ³³⁰

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is insufficient data standards to ensure data is comparable in Mozambique.

The Health Information System for Monitoring and Evaluation (SIS-MA) includes an interoperability platform, which functions as an intermediary layer facilitating interoperability processes between SIS-MA and other systems. ³³¹ Moreover, according to its User Handbook (2015), the entry of data in SIS-MA is done through filling forms, ensuring comparative data. ³³² However, SIS-MA is not publicly accessible, as access requires a login and password and there is no evidence anyone can create an account. ³³³ ³³⁴

2.4.2 Data integration between human, animal and environmental health sectors

2.4.2a Data sharing mechanisms

Score: 0

There is no evidence Mozambique has established mechanisms at the relevant ministries responsible for animal, human, and wildlife surveillance to share data.

The Ministry of Health (MISAU) manages the Health Information System for Monitoring and Evaluation (SIS-MA), an open-source, web-based platform designed to support the collection, storage, analysis, interpretation, visualization, and dissemination of health information used to inform and monitor public health policies at the national level. ³³⁵ SIS-MA is intended to gather data on various aspects of health, including demographic information, health indicators, healthcare service coverage, epidemiology, and human resources in the health sector. The system is also used to generate reports, analyze data, and share information among a wide range of stakeholders, including health organizations, development partners, government agencies, and non-governmental organizations. ³³⁶ However, there is no information whether it accounts for other ministries other than MISAU. ³³⁷

As part of SIS-MA, MISAU operates the Epidemiological Surveillance Information System (SIVE), a dedicated module designed to collect, analyze, and interpret epidemiological data in real time to enable a rapid and effective response to disease outbreaks and facilitates the recording of data related to vaccination campaigns targeting diseases under surveillance. ³³⁸ However, neither SIS-MA nor SIVE is publicly accessible, as access requires a login and password and there is no evidence anyone can create an account. ³³⁹

2.4.3 Transparency of surveillance data

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 0

There is no evidence Mozambique makes de-identified health surveillance data on infectious diseases publicly available via reports on government websites.

The National Health Institute of Mozambique (INS, Instituto Nacional de Saúde) publishes data related to HIV. ³⁴⁰ However, there is no indication that it includes data on other infectious diseases such as chikungunya, Ebola, or influenza. ³⁴¹

Similarly, the Ministry of Health (MISAU) releases data on HIV and malaria, but there is no evidence of reporting on other infectious diseases. ³⁴² Moreover, this data is not publicly accessible as you require a login and a password to access the data. ³⁴³

The National Statistics Institute (INE, Instituto Nacional de Estatística) publishes general health-related data; however, there is no indication that it covers infectious diseases. ³⁴⁴

The Ministry of Agriculture, the Environment, and Fisheries (MAAP) publishes the Integrated Agrarian Survey, with the most recent edition released in 2023. ³⁴⁵ This survey includes information on livestock losses due to disease (not limited to infectious causes), theft, and other factors. ³⁴⁶ ³⁴⁷ However, it does not specify the diseases responsible for the reported losses. ³⁴⁸

According to the World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016), it is recommended to Mozambique to "increase funding and technical assistance for antimicrobial resistance research and surveillance to generate data on the true burden and epidemiology of antimicrobial resistance in Mozambique". ³⁴⁹ It also adds that "sensitivity of the current national surveillance system is weak with significant under-reporting, poor quality of collected data, and very limited coverage of rural areas. Furthermore the list of mandatory disease has not been updated since 1979". ³⁵⁰

In May 2024, MISAU, INS and INE published the Demographics and Health Survey 2022-2023, which is focused on providing updated estimates pertaining to demographics and health of Mozambique in order to monitor public policies. ³⁵¹ However, it does not present data on infectious diseases. ³⁵²

2.4.4 Ethical considerations during surveillance

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

The Mozambican legislative framework safeguards the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities.

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 100

The Mozambican legal framework safeguarding the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities, include mention of protections from cyber attacks (e.g. ransomware).

Mozambique has ratified the African Union Convention on Cybersecurity on 2 December 2019, which includes articles that specifically deal with the health information of individuals. ³⁵⁷ Pursuant to Article 10, the "processing of personal data involving genetic information and health research" must be-identified. ³⁵⁸ The document outlines some general practices and guidelines for personal data to be accessed, in order to safeguard their confidentiality, such as the requirement to provide the purpose of the use of data, the details on how the data will be processed, and others. Article 10 also covers data involving offenses and convictions, biometric data, and others. ³⁵⁹ Additionally, in accordance with Article 25, Section (1), "each State Party must adopt legislative and/or regulatory measures it deems effective to classify as substantive criminal offences any acts that affect the confidentiality, integrity, availability, and survival of information and communication technology systems, the data they process, and the underlying network infrastructures. It must also adopt effective measures for the investigation and prosecution of offenders. State Parties should take into consideration the choice of language used in international best practices". ³⁶⁰

Furthermore, as per Article 29, Section (2), State Parties must take legislative action to criminalize violations of data privacy, including: (i) fraudulently intercepting or attempting to intercept, through technical means, computer data during its non-public transmission to, from, or within a computer system; (ii) fraudulently obtaining, for oneself or for another, any benefit through the insertion, alteration, deletion, or suppression of computer data, or by any other means that interferes with the functioning of a computer system; (iii) participating in an association formed or an agreement established with the intent to prepare or commit one or more of the offences set forth in this Convention; and other related acts. ³⁶¹

2.4.5 International data sharing

2.4.5a Cooperative commitments or agreements within regions

Score: 0

There is no evidence Mozambique made a committment to share surveillance data during a public health emergency with other countries.

Pursuant to Article 16, Section 2, of Law No. 3 of 10 February 2022, the Government of Mozambique is authorized to declare a public health emergency in the event of an outbreak, epidemic, syndemic, or pandemic that presents a high level of danger and necessitates a coordinated response involving local, national, or international stakeholders. ³⁶² However, the law does not include any provisions regarding commitments to data sharing. ³⁶³

Additionally, Mozambique is a member of the Southern African Development Community (SADC). ³⁶⁴ Pursuant to Article 6 of SADC's Protocol on Health, all member states shall (i) share information on health systems research and surveillance, and cooperate and assist each other in its disseminations, and (ii) cooperate and assist each other in regional surveillance with respect to communicable and non-communicable diseases, and to develop a common set of indicators for these diseases. ³⁶⁵ However, there is no specific mention of data-sharing at times of public health emergencies. ³⁶⁶

2.5 Case-based investigation

2.5.1 Case investigation and contact tracing

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 0

There is no evidence Mozambique has a national system in place to provide support at the sub-national level to conduct contact tracing in the event of a public health emergency.

The Emergency Operations Center in Public Health (COESP, Centro de Operações de Emergência em Saúde Pública), under the purview of the National Public Health Directorate (DNSP) of the Ministry of Health (MISAU), is focused on the coordination and preparation to respond to public health emergencies. ³⁶⁷ ³⁶⁸ ³⁶⁹ Nevertheless, there is no mention that COESP supports local-level contact tracing through training, metrics standardization or financial resources. ³⁷⁰ ³⁷¹ ³⁷²

There is no further information on the official websites of MISAU or the National Health Institute (INS, Instituto Nacional de Saúde). ³⁷³ ³⁷⁴

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

Mozambique does not provide wraparound services to enable infected people and their contacts to self-isolate or quarantine as recommended, particularly related to economic support and medical attention.

Article 18, Section 1, of Law No. 3 of 10 February 2022, mandates quarantine for infected or suspected individuals in case of declaration of Public Health Emergency, while Article 19 states that self-isolation can be home or institutional. ³⁷⁵ However, there is no mention of economic support or medical attention. ³⁷⁶

Article 134 of Labour Law (Law No. 13 of 25 August 2023) enables the suspension of labour contracts due to unforeseen circumstances, including epidemics and pandemics, if it predictably affects the regular operation of the company. ³⁷⁷

2.5.2 Point of entry management

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is no evidence of a joint plan or cooperative agreement between the public health system and border control authorities in Mozambique to identify suspected and potential cases in international travelers and trace and quarantine their contacts in the event of a public health emergency.

Pursuant to Article 23 of Law No. 3 of 10 February 2022, health authorities in Mozambique are empowered to establish rules concerning the entry and exit of individuals. ³⁷⁸ In accordance with Article 24, all means of transportation and their crews are subject to health control measures to mitigate public health risks, and in such cases, the health authorities must be notified. ³⁷⁹ Article 26 further provides that travelers, whenever necessary, are required to present themselves to health authorities at points of entry into the country, including seaports, airports, and land border posts, for disease screening or to provide any information needed for public health risk assessment. Additionally, any traveler who is ill, or suspected of carrying a disease that poses a public health risk, is obligated to report to health authorities at the point of entry so that appropriate transmission prevention measures can be implemented. ³⁸⁰ While these provisions aim to facilitate the identification of suspected and potential cases among international travelers, as well as the tracing and quarantine of their contacts, there is no mention of formal agreements or coordination mechanisms with border control authorities. ³⁸¹

The COVID-19 Outbreak Preparation and Response Plan (2020), updated in 2021, which had a full chapter dedicated to outlining the cooperation between public health authorities and authorities in points of entry into the country, is no longer active. ³⁸² ³⁸³ ³⁸⁴

2.6 Epidemiology workforce

2.6.1 Existence of applied epidemiology training program such FETP and FETPV

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

There are applied epidemiology training programs available in Mozambique.

According to the World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016), "Field Epidemiology and Laboratory Training Program (FELTP) has been implemented in Mozambique since 2010". ³⁸⁵ It also states that the country has developed a "comprehensive regular training package on disease surveillance for health professionals through in-service training, supportive supervisions, technical meetings, and the FELTP". ³⁸⁶

The FELTP was established to offer an advanced field epidemiology course coordinated by the National Health Institute (INS, Instituto Nacional de Saúde) in partnership with University Eduardo Mondlane Faculty of Medicine, with technical and financial support from the US Centers for Disease Prevention and Control (CDC). ³⁸⁷

According to the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET), the program has successfully trained 46 health professionals through its Advanced-level. ³⁸⁸

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

There is a specific animal health field epidemiology training program offered in Mozambique.

In 2022, Mozambique launched the In-Service Applied Veterinary Epidemiology Training Program (ISAVET), which aims to strengthen the capacity to detect and respond quickly and effectively to transboundary animal diseases, as well as emerging infectious diseases. ³⁸⁹ ISAVET, implemented by the Ministry of Agriculture, the Environment, and Fisheries (MAAP) through the National Directorate of Animal Development (DNDP) in collaboration with the Faculty of Veterinary Medicine, received technical support from the Food and Agriculture Organization (FAO). ³⁹⁰

According to the DNDP, the program is a consequence of the recommendations provided in the Joint External Evaluation. ³⁹¹

2.6.2 Epidemiology workforce capacity

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 0

Mozambique does not have at least 1 trained field epidemiologist per 200,000 people.

According to the United Nations, Mozambique has a population of approximately 33.7 million inhabitants. ³⁹² According to the African Field Epidemiology Network (AFENET), Mozambique had 64 epidemiologists in August 2023. ³⁹³

Thus, Mozambique has at least 1 trained field epidemiologist per 526,560 people. ³⁹⁴ ³⁹⁵

Rapid Response

3.1 Emergency preparedness and response planning

3.1.1 National public health emergency preparedness and response plan

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 0

Mozambique does not have an overarching national public health emergency response plan in place.

On 14 June 2023, the Ministry of Health (MISAU) issued a directive establishing the Public Health Emergency Committee (CESP, Comité de Emergências de Saúde Pública no Ministério da Saúde). ³⁹⁶ Pursuant to Article 3, CESP is tasked with coordinating, overseeing, and monitoring preparedness, response, and recovery efforts related to public health emergencies. ³⁹⁷ In accordance with Article 4, Section 1, Subsection (d), CESP is also responsible for approving public health emergency plans and overseeing their implementation. ³⁹⁸

In May 2022, MISAU, through the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde) and the National Directorate of Public Health (DNSP), a workshop to update the National Action Plan for Health Security (PNASS, Plano Nacional de Acção para Segurança Sanitária) for 2023-2027. ³⁹⁹ According to the INS, the discussions around PNASS for 2023-2027 covered multiple threat types, such as antimicrobial resistance, zoonotic diseases, and others. ⁴⁰⁰ However, there is no evidence that PNASS has been published on the websites of MISAU, INS or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ⁴⁰¹ ⁴⁰² ⁴⁰³

Mozambique has not submitted a National Action Plan for Health Security (NAPHS) before the World Health Organization (WHO). ⁴⁰⁴

3.1.1b National public health emergency response plan published in past 3 years

Score: 0

Mozambique does not have an overarching national public health emergency response plan in place.

On 14 June 2023, the Ministry of Health (MISAU) issued a directive establishing the Public Health Emergency Committee (CESP, Comité de Emergências de Saúde Pública no Ministério da Saúde). ⁴⁰⁶ Pursuant to Article 3, CESP is tasked with coordinating, overseeing, and monitoring preparedness, response, and recovery efforts related to public health emergencies. ⁴⁰⁷ In accordance with Article 4, Section 1, Subsection (d), CESP is also responsible for approving public health emergency plans and overseeing their implementation. ⁴⁰⁸

In May 2022, MISAU, through the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde) and the National Directorate of Public Health (DNSP), a workshop to update the National Action Plan for Health Security (PNASS, Plano Nacional de Acção para Segurança Sanitária) for 2023-2027. ⁴⁰⁹ According to the INS, the discussions around PNASS for 2023-2027 covered multiple threat types, such as antimicrobial resistance, zoonotic diseases, and others. ⁴¹⁰ However, there is no evidence that PNASS has been published on the websites of MISAU, INS or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ⁴¹¹ ⁴¹² ⁴¹³

Mozambique has not submitted a National Action Plan for Health Security (NAPHS) before the World Health Organization (WHO). ⁴¹⁴

3.1.1c One health principles by covering multiple threat types

Score: 0

Mozambique does not have an overarching national public health emergency response plan in place.

On 14 June 2023, the Ministry of Health (MISAU) issued a directive establishing the Public Health Emergency Committee (CESP, Comité de Emergências de Saúde Pública no Ministério da Saúde). ⁴¹⁶ Pursuant to Article 3, CESP is tasked with coordinating, overseeing, and monitoring preparedness, response, and recovery efforts related to public health emergencies. ⁴¹⁷ In accordance with Article 4, Section 1, Subsection (d), CESP is also responsible for approving public health emergency plans and overseeing their implementation. ⁴¹⁸

In May 2022, MISAU, through the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde) and the National Directorate of Public Health (DNSP), a workshop to update the National Action Plan for Health Security (PNASS, Plano Nacional de Acção para Segurança Sanitária) for 2023-2027. ⁴¹⁹ According to the INS, the discussions around PNASS for 2023-2027 covered multiple threat types, such as antimicrobial resistance, zoonotic diseases, and others. ⁴²⁰ However, there is no evidence that PNASS has been published on the websites of MISAU, INS or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ⁴²¹ ⁴²² ⁴²³

Mozambique has not submitted a National Action Plan for Health Security (NAPHS) before the World Health Organization (WHO). ⁴²⁴

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

Mozambique does not have an overarching national public health emergency response plan in place.

On 14 June 2023, the Ministry of Health (MISAU) issued a directive establishing the Public Health Emergency Committee (CESP, Comité de Emergências de Saúde Pública no Ministério da Saúde). ⁴²⁶ Pursuant to Article 3, CESP is tasked with coordinating, overseeing, and monitoring preparedness, response, and recovery efforts related to public health emergencies. ⁴²⁷ In accordance with Article 4, Section 1, Subsection (d), CESP is also responsible for approving public health emergency plans and overseeing their implementation. ⁴²⁸

In May 2022, MISAU, through the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde) and the National Directorate of Public Health (DNSP), a workshop to update the National Action Plan for Health Security (PNASS, Plano Nacional de Acção para Segurança Sanitária) for 2023-2027. ⁴²⁹ According to the INS, the discussions around PNASS for 2023-2027 covered multiple threat types, such as antimicrobial resistance, zoonotic diseases, and others. ⁴³⁰ However, there is no evidence that PNASS has been published on the websites of MISAU, INS or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ⁴³¹ ⁴³² ⁴³³

Mozambique has not submitted a National Action Plan for Health Security (NAPHS) before the World Health Organization (WHO). ⁴³⁴

3.1.2 Private sector involvement in response planning

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 100

Mozambique has a specific mechanism for engaging with the private sector to assist with outbreak emergency preparedness and response.

On 14 June 2023, the Ministry of Health (MISAU) issued a directive establishing the Public Health Emergency Committee (CESP, Comité de Emergências de Saúde Pública no Ministério da Saúde). ⁴³⁶ Pursuant to Article 3, CESP is tasked with coordinating, overseeing, and monitoring preparedness, response, and recovery efforts related to public health emergencies. ⁴³⁷ In accordance with Article 4, Section 1, Subsection (d), CESP is also responsible for approving public health emergency plans and overseeing their implementation. ⁴³⁸

As per Article 2, Section 2, of Directive of 14 June 2023, CESP is comprised of several areas of MISAU, including the National Institute of Health of Mozambique (INS, Instituto Nacional de Saúde), the National Directorate of Public Health, the Medical Emergency Service of Mozambique (SEMMO, Serviço de Emergências Médicas de Moçambique), and others. ⁴³⁹ According to Article 2, Section 4, representatives of other areas of the government, as well as representatives of the private sector and specialists in the health sector can be invited to participate in the meetings. ⁴⁴⁰

3.1.3 Non-pharmaceutical interventions planning

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 50

There is evidence Mozambique has a policy in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic.

Pursuant to Article 18 of Law No. 3 of 10 February 2022, which sets forth provisions for disease control and prevention, quarantine is mandatory during a state of public health emergency, and the procedures and guidelines established by the health authorities must be followed. ⁴⁴¹ The measure may be lifted or maintained based on epidemiological assessment and includes the prohibition of activities likely to spread the disease, restrictions on movement into and out of areas with infected persons (including border crossings), and the establishment of temporary facilities for observation, diagnosis, and treatment. ⁴⁴² In addition, Article 19 provides that health authorities may order isolation, whether institutional or home-based. ⁴⁴³ If these measures are not respected, the State may impose coercive measures, including imprisonment, in accordance with Article 37. ⁴⁴⁴

3.2 Exercising response plans

3.2.1 Activating response plans

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 100

Mozambique has completed a national-level biological threat-focused exercise in the past year.

Between October 2024 and January 2025, Mozambique monitored the Marburg virus outbreak in neighboring Tanzania. ⁴⁴⁵ ⁴⁴⁶ ⁴⁴⁷ Although the country did not declare the situation a public health emergency or activate a national emergency response plan, the Ministry of Health (MISAU), in collaboration with VillageReach and other partners, conducted a tabletop simulation exercise in October 2024 focused on preparedness, readiness, and response to a potential Marburg outbreak. ⁴⁴⁸

The workshop brought together chief medical officers, managers, and technical staff from various sectors, including the Expanded Program on Immunization, Surveillance, Environmental Health, Communication, and Community Engagement. The exercise formed part of broader efforts to strengthen the Public Health Emergency Operation Center (PHEOC). ⁴⁴⁹

Moreover, in April 2025, Mozambique, alongside other countries and 20 regional agencies, participated in a global simulation about a new pandemic, conducted by the World Health Organization (WHO). ⁴⁵⁰ The Exercise Polaris initiative tested the WHO Global Health Emergency Corps to strengthen the capacity of emergency personnel, coordinate the deployment of teams and experts, and enhance collaboration between countries. ⁴⁵¹

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 0

There is no evidence Mozambique identified a list of gaps and best practices in response and developed a plan to improve response capabilities.

Between October 2024 and January 2025, Mozambique monitored the Marburg virus outbreak in neighboring Tanzania. ⁴⁵² ⁴⁵³ ⁴⁵⁴ Although the country did not declare the situation a public health emergency or activate a national emergency response plan, the Ministry of Health (MISAU), in collaboration with VillageReach and other partners, conducted a tabletop simulation exercise in October 2024 focused on preparedness, readiness, and response to a potential Marburg outbreak. ⁴⁵⁵

In 2020, Mozambique used after action reviews (AARs) to improve future response after a cyclone. ⁴⁵⁷ However, it did not occur in the past year. ⁴⁵⁸

However, there is no evidence that this led to a formal plan to improve response capabilities on the official websites of the Ministry of Health (MISAU), the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), the Ministry of Agriculture, the Environment, and Fisheries (MAAP), or the Ministry of National Defense. ⁴⁵⁹ ⁴⁶⁰ ⁴⁶¹ ⁴⁶²

3.2.2 Private sector engagement in exercises

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 100

Mozambique has undergone a national-level biological threat-focused exercise that has included private sector representatives in the past year.

Between October 2024 and January 2025, Mozambique monitored the Marburg virus outbreak in neighboring Tanzania. ⁴⁶³ ⁴⁶⁴ ⁴⁶⁵ Although the country did not declare the situation a public health emergency or activate a national emergency response plan, the Ministry of Health (MISAU), in collaboration with VillageReach and other partners, conducted a tabletop simulation exercise in October 2024 focused on preparedness, readiness, and response to a potential Marburg outbreak. ⁴⁶⁶ VillageReach is an organization that works with governments, the private sector, partners and communities to build responsive primary health care systems that deliver health products and services to the most under-reached, closely working with communities, and gathering and acting on their insights. ⁴⁶⁷ ⁴⁶⁸

3.3 Emergency response operation

3.3.1 Emergency response operation

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

Mozambique has an Emergency Operations Center in place.

Additionally, as per the World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016), Mozambique "established a national emergency operations centre (CENOE), a multisector coordination and decision-making structure that brings together representatives of institutions, organizations and groups of actors directly involved in response operations to natural disasters and other emergencies. The centre’s mission is to centralize inter-sectoral coordination efforts in order to respond rapidly, efficiently, and effectively to natural disasters and emergencies. In addition to CENOE operations in Maputo, there are also three regional EOCs located throughout the country."⁴⁷³ CENOE is under the purview of the National Institute for Disaster Risk Reduction and Management (INGD, Instituto Nacional de Gestão e Redução do Risco de Desastres). ⁴⁷⁴

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

The Emergency Operations Center in Mozambique is neither required to conduct a drill for a public health emergency scenario at least once per year, nor has conducted a drill at least once per year.

The Emergency Operations Center in Public Health (COESP, Centro de Operações de Emergência em Saúde Pública), under the purview of the National Public Health Directorate (DNSP) of the Ministry of Health (MISAU), is focused on the coordination and preparation to respond to public health emergencies. ⁴⁷⁵ ⁴⁷⁶ ⁴⁷⁷ However, there is no mention of a requirement for annual drills. ⁴⁷⁸ ⁴⁷⁹ ⁴⁸⁰

Additionally, as per the World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016), Mozambique "established a national emergency operations centre (CENOE), a multisector coordination and decision-making structure that brings together representatives of institutions, organizations and groups of actors directly involved in response operations to natural disasters and other emergencies. The centre’s mission is to centralize inter-sectoral coordination efforts in order to respond rapidly, efficiently, and effectively to natural disasters and emergencies. In addition to CENOE operations in Maputo, there are also three regional EOCs located throughout the country.". ⁴⁸¹ CENOE is under the purview of the National Institute for Disaster Risk Reduction and Management (INGD, Instituto Nacional de Gestão e Redução do Risco de Desastres). ⁴⁸²

According to the JEE, "CENOE conducts annual simulations, and have also had simulations with community participation which have helped to sensitize the communities on the need for prevention" (p. 42). ⁴⁸³ However, the same document also notes that the simulations are for general emergencies, not specifically for health-related emergencies, including pandemics; an area that needs strengthening, according to JEE 2016, is capacity for preparedness and response to outbreaks and emergencies including simulation exercises for epidemiological incidents (p. 40). ⁴⁸⁴ However, there is no mention of a requirement for annual drills. ⁴⁸⁵ ⁴⁸⁶ ⁴⁸⁷

There is no evidence that COESP has conducted such procedures at least once a year on the official websites of MISAU, the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), the Ministry of Agriculture, the Environment, and Fisheries (MAAP), or the Ministry of National Defense. ⁴⁸⁸ ⁴⁸⁹ ⁴⁹⁰ ⁴⁹¹ The official website of the National Institute for Disaster Risk Reduction and Management was not operational. ⁴⁹²

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no evidence that the Mozambican Emergency Operations Center in Public Health (COESP) has conducted within the last year a coordinated emergency response or emergency response exercise activated within 120 minutes of the identification of the public health emergency.

There is no evidence of such procedures on the official websites of the Ministry of Health (MISAU), the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde), the Ministry of Agriculture, the Environment, and Fisheries (MAAP), or the Ministry of National Defense. ⁴⁹³ ⁴⁹⁴ ⁴⁹⁵ ⁴⁹⁶ The official website of the National Institute for Disaster Risk Reduction and Management was not operational. ⁴⁹⁷

3.4 Linking public health and security authorities

3.4.1 Public health and security authorities linked for a biological event

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no evidence that Mozambique either carried out an exercise to respond to a potential deliberate biological event (i.e., bioterrorism attack) or enacted standard operating procedures, guidelines, memorandums of understanding (MOUs), or other agreements between the public health, animal health, the private sector and security authorities to respond to a potential deliberate biological event.

The World Health Organization's (WHO) Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Mozambique (2016) states that "there are currently no written agreements between public health authorities and security authorities, or entities from other sectors, regarding linkages or collaboration between public health and security sectors and this happens on an ad hoc basis". ⁴⁹⁸ The document stated that a MOU was being finalized between the Ministry of Health (MISAU) and security authorities on the issue; however, there is no evidence that is has been finalized on the official websites of MISAU, the National Health Institute (INS), the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique), or the Ministry of National Defense. ⁴⁹⁹ ⁵⁰⁰ ⁵⁰¹ ⁵⁰² ⁵⁰³

The JEE (2016) also stated that "Exercises were conducted by the Ministry of Health during Ebola preparedness activities, with inter-sectoral collaboration with security authorities", but outlined that there were "no standard operating procedures in place for joint risk assessment but events of public health and security significance are discussed at regular or extraordinary meetings of government structures at all levels". ⁵⁰⁴

The Biosecurity and Bioprotection Handbook (2022), published by INS, mentions that Mozambique does not have a record of bioterrorist attacks, but that institutions that store and process biological material with potential to be used in bioterrorism attacks to adopt measures of bioprotection to contain its impacts. ⁵⁰⁵ However, it does not detail which measures of protection should be applied. ⁵⁰⁶

There is no evidence of exercises to respond to potential deliberate biological events either. ⁵⁰⁷ ⁵⁰⁸ ⁵⁰⁹ ⁵¹⁰

3.5 Risk communication

3.5.1 Risk communication planning

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 0

Mozambique does not have a document with a section detailing a risk communication plan that is specifically intended for use during a public health emergency.

In May 2022, the Ministry of Health (MISAU), through the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde) and the National Directorate of Public Health (DNSP), conducted a workshop to update the National Action Plan for Health Security (PNASS, Plano Nacional de Acção para Segurança Sanitária) for 2023-2027. ⁵¹¹ According to the INS, the discussions around PNASS for 2023-2027 covered multiple threat types, such as antimicrobial resistance, zoonotic diseases, and others. ⁵¹² However, there is no evidence that PNASS has been published on the websites of MISAU, INS or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ⁵¹³ ⁵¹⁴ ⁵¹⁵

Mozambique has not submitted a National Action Plan for Health Security (NAPHS) before the World Health Organization (WHO). ⁵¹⁶

On 16 April 2021, Mozambique enacted its Health Policy and Strategy for its Implementation through Resolution No. 13/2021. ⁵¹⁷ The document seeks to promote the enhancement of health conditions and lifestyle of populations; however, there is no mention of a communication plan for public health emergencies. ⁵¹⁸

The World Health Organization's (WHO) Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Mozambique (2016) identified as a priority action the need to strengthen risk communication and public communication by establishing a website or information portal dedicated to risk communication, risk management, and emergency reporting. ⁵¹⁹ The evaluation noted that “risk communication is inadequate and rarely done in a timely manner (i.e., within 24 hours); a website needs to be set up for this and to send out emergency reports.” ⁵²⁰

However, the JEE also acknowledged that the Ministry of Health (MISAU) "has a strategy for greater media engagement, in which health professionals participate in disseminating key messages related to cholera and other diarrheal diseases through radio, television, and public and community". ⁵²¹ The report emphasized that the "scope of the communication plan should be diversified beyond health promotion for cholera and diarrhoea to include other diseases". ⁵²²

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 0

Mozambique does not have a risk communication plan.

In May 2022, the Ministry of Health (MISAU), through the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde) and the National Directorate of Public Health (DNSP), conducted a workshop to update the National Action Plan for Health Security (PNASS, Plano Nacional de Acção para Segurança Sanitária) for 2023-2027. ⁵²³ According to the INS, the discussions around PNASS for 2023-2027 covered multiple threat types, such as antimicrobial resistance, zoonotic diseases, and others. ⁵²⁴ However, there is no evidence that PNASS has been published on the websites of MISAU, INS or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ⁵²⁵ ⁵²⁶ ⁵²⁷

Mozambique has not submitted a National Action Plan for Health Security (NAPHS) before the World Health Organization (WHO). ⁵²⁸

On 16 April 2021, Mozambique enacted its Health Policy and Strategy for its Implementation through Resolution No. 13/2021. ⁵²⁹ The document seeks to promote the enhancement of health conditions and lifestyle of populations; however, there is no mention of a communication plan for public health emergencies. ⁵³⁰

The World Health Organization's (WHO) Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Mozambique (2016) identified as a priority action the need to strengthen risk communication and public communication by establishing a website or information portal dedicated to risk communication, risk management, and emergency reporting. ⁵³¹ The evaluation noted that “risk communication is inadequate and rarely done in a timely manner (i.e., within 24 hours); a website needs to be set up for this and to send out emergency reports.” ⁵³²

However, the JEE also acknowledged that the Ministry of Health (MISAU) "has a strategy for greater media engagement, in which health professionals participate in disseminating key messages related to cholera and other diarrheal diseases through radio, television, and public and community". ⁵³³ The report emphasized that the "scope of the communication plan should be diversified beyond health promotion for cholera and diarrhoea to include other diseases". ⁵³⁴

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 0

Mozambique does not have a risk communication plan.

In May 2022, the Ministry of Health (MISAU), through the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde) and the National Directorate of Public Health (DNSP), conducted a workshop to update the National Action Plan for Health Security (PNASS, Plano Nacional de Acção para Segurança Sanitária) for 2023-2027. ⁵³⁵ According to the INS, the discussions around PNASS for 2023-2027 covered multiple threat types, such as antimicrobial resistance, zoonotic diseases, and others. ⁵³⁶ However, there is no evidence that PNASS has been published on the websites of MISAU, INS or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ⁵³⁷ ⁵³⁸ ⁵³⁹

Mozambique has not submitted a National Action Plan for Health Security (NAPHS) before the World Health Organization (WHO). ⁵⁴⁰

On 16 April 2021, Mozambique enacted its Health Policy and Strategy for its Implementation through Resolution No. 13/2021. ⁵⁴¹ The document seeks to promote the enhancement of health conditions and lifestyle of populations; however, there is no mention of a communication plan for public health emergencies. ⁵⁴²

The World Health Organization's (WHO) Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Mozambique (2016) identified as a priority action the need to strengthen risk communication and public communication by establishing a website or information portal dedicated to risk communication, risk management, and emergency reporting. ⁵⁴³ The evaluation noted that “risk communication is inadequate and rarely done in a timely manner (i.e., within 24 hours); a website needs to be set up for this and to send out emergency reports.” ⁵⁴⁴

However, the JEE also acknowledged that the Ministry of Health (MISAU) "has a strategy for greater media engagement, in which health professionals participate in disseminating key messages related to cholera and other diarrheal diseases through radio, television, and public and community". ⁵⁴⁵ The report emphasized that the "scope of the communication plan should be diversified beyond health promotion for cholera and diarrhoea to include other diseases". ⁵⁴⁶

3.5.2 Public health systems communication

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 50

There is evidence that Mozambique's public health system has actively shared messages via online media platforms to inform the public about ongoing public health concerns, and/or dispel rumours, misinformation or disinformation.

IIn January 2024, the Ministry of Health (MISAU) publicly dismissed rumours concerning the circulation of a new variant of COVID-19 in the country, through online media outlets and its social media profiles. ⁵⁴⁷ ⁵⁴⁸ MISAU published a press release on the epidemiological situation of influenza-like illness on its X (formerly Twitter) profile, in which it reported an increase in COVID-19 cases but denied rumours of the emergence of a new variant of COVID-19. The Ministry also reinforced measures to prevent transmission, including respiratory etiquette, reinforcement of individual and collective hygiene, regular disinfection or washing of hands, and the use of masks by individuals with acute respiratory symptoms. ⁵⁴⁹

In August 2024, MISAU dismissed rumours about confirmed monkeypox (Mpox) cases by clarifying that seven suspected cases had tested negative. ⁵⁵⁰ ⁵⁵¹

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no evidence that senior leaders (president or ministers) in Mozambique have shared misinformation or disinformation on infectious diseases in the past two years.

There is no evidence of disinformation or misinformation related to infectious diseases shared by senior leaders in Mozambique on the media outlets O País, Jornal Notícias, or Diário Económico. ⁵⁵² ⁵⁵³ ⁵⁵⁴ There is no evidence of such remarks on the websites of the Ministry of Health (MISAU) or the National Health Institute (INS) either. ⁵⁵⁵ ⁵⁵⁶

In August 2025, the National Public Health Director of Mozambique, Quinhas Fernandes, publicly urged the public to avoid panic and misinformation related to monkeypox (Mpox) in order to combat potential discrimination against affected individuals. ⁵⁵⁷ Fernandes made “a very strong appeal to prevent misinformation and panic because, for example, in Maputo Province, as you may recall, we had a case of Mpox in 2022 that was perfectly controlled without any kind of misinformation (…). It is important not to discriminate against patients who have Mpox.” ⁵⁵⁸

Moreover, the Governor of Cabo Delgado, Valige Tauabo, warned that the spread of misinformation about cholera was the main factor contributing to the propagation of the disease in the province. ⁵⁵⁹

3.6 Access to communications infrastructure

3.6.1 Internet users

3.6.1a Percentage of households with Internet

Score: 10.8

3.6.2 Mobile subscribers

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 0

3.6.3 Female access to a mobile phone

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 56.67

3.6.4 Female access to the Internet

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 54.17

3.7 Trade and travel restrictions

3.7.1 Trade restrictions

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

There is no evidence Mozambique has implemented restrictions on export/import of medical goods due to an infectious disease outbreak.

There is no evidence of such restrictions on the official websites of the Ministry of Health (MISAU), the National Health Institute (INS), the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique), the Ministry of National Defense, the Tax Authority of Mozambique, or the Ministry of Economics and Finance. ⁵⁶⁰ ⁵⁶¹ ⁵⁶² ⁵⁶³ ⁵⁶⁴ ⁵⁶⁵

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

There is no evidence Mozambique has implemented restrictions on export/import of non-medical goods (e.g. food, textiles, etc) due to an infectious disease outbreak in the past year.

In 2017, Mozambique ban the import of chicken meat; however, the measure was adopted due to local producers' phytosanitary concerns, and not an infectious disease outbreak. ⁵⁶⁶ ⁵⁶⁷

In 2023, Mozambique banned the import of chicken meat and chicken eggs from South Africa due to an outbreak of Avian influenza, leading the country to purchase these goods from Brazil and Turkiye. ⁵⁶⁸ ⁵⁶⁹

However, there is no evidence of restrictions on export/import of non-medical goods in 2024 and 2025 due to an infectious disease outbreak on the official websites of the Ministry of Health (MISAU), the National Health Institute (INS), the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique), the Ministry of National Defense, the Tax Authority of Mozambique, or the Ministry of Economics and Finance. ⁵⁷⁰ ⁵⁷¹ ⁵⁷² ⁵⁷³ ⁵⁷⁴ ⁵⁷⁵

3.7.2 Travel restrictions

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

There is no evidence Mozambique has implemented inbound or outbound travel restrictions due to an infectious disease outbreak in the past year.

There is no evidence of inbound or outbound travel restrictions in 2024 and 2025 due to an infectious disease outbreak on the official websites of the Ministry of Health (MISAU), the National Health Institute (INS), the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique), the Ministry of National Defense, the Tax Authority of Mozambique, or the Ministry of Foreign Affairs and Cooperation, or the Ministry of Culture and Tourism. ⁵⁷⁶ ⁵⁷⁷ ⁵⁷⁸ ⁵⁷⁹ ⁵⁸⁰ ⁵⁸¹ ⁵⁸²

In 2020, Mozambique enacted Law No. 4 of 30 April 2020, which extended the emergency state due to COVID-19. ⁵⁸³ Pursuant to Article 4, Section (2), Subsection (d), there was inbound and outbound travel restrictions due to COVID-19, leading to the partial closure of borders, except in cases of State interest, humanitarian aid, health and cargo transportation. ⁵⁸⁴ In 2021, the restrictions were partially lifted, but negative tests for COVID-19 were required to enter the country. ⁵⁸⁵ In April 2022, the travel restrictions were lifted. ⁵⁸⁶

3.7.2b Risk-based approach to international travel-related measures

Score: 100

Mozambique uses a risk-based approach to international travel-related measures.

Mozambique requires a yellow fever vaccination certificate from travellers who have visited any of 43 countries, namely: Angola, Benin, Bolivia, Brazil, Burkina Faso, Burundi, Cameroon, Chad, Colombia, Congo, Côte d’Ivoire, Ecuador, Ethiopia, French Polynesia, Gabon, Gambia, Ghana, Guyana, Guinea, Guinea-Bissau, Equatorial Guinea, Liberia, Mali, Mauritania, Niger, Nigeria, Panama, Peru, Kenya, Central African Republic, Democratic Republic of the Congo, Rwanda, Somalia, São Tomé and Príncipe, Senegal, Sierra Leone, Sudan, Suriname, Tanzania, Togo, Trinidad and Tobago, Uganda, and Venezuela. ⁵⁸⁷ These countries are included in the World Health Organization (WHO) list of countries with risk of yellow fever transmission. ⁵⁸⁸

According to the WHO, a risk-based approach refers to adjusting border, quarantine, certificate and testing policies based on actual public health risks rather than imposing indiscriminate restrictions. ⁵⁸⁹

Health System

4.1 Health capacity in clinics, hospitals and community care centers

4.1.1 Available human resources for the broader healthcare system

4.1.1a Doctors per 100,000 people

Score: 2.09

4.1.1b Nurses and midwives per 100,000 people

Score: 5.59

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 100

Mozambique has a health workforce strategy in place to identify fields where there is insufficient workforce and strategies to address these shortcomings.

The National Plan for the Development of Human Resources for the Health Sector 2016-2025 (2016) (PNDRHS), enacted by the Ministry of Health (MISAU), provides an analysis of the situation of human resources for the health sector in Mozambique, identifies the key objectives and indicators which includes estimates and forecasts for the health sector labour market as well as strategies to develop and grow health workers in Mozambique. ⁵⁹⁰ The PNDRHS explicitly mentions shortcomings of labour, notably in the field of surgical teams (instrumentalists and anaesthesiologists) (p. 59). ⁵⁹¹ Strategies include the retaining of health professional in the field, increase satisfaction in their work, and provide stronger legal and institutional support for health workers, as they are listed in the contents page. ⁵⁹²

4.1.1d Health system capacity for essential health services

Score: 0

The Mozambican health system has insufficient capacity to deliver essential health services.

The Joint external evaluation of IHR core capacities of Mozambique (2016) scores the country a 4 on this measure, the highest possible, citing how simulation exercises have been conducted in the context of pandemic influenza and Ebola preparedness, which partially addressed issues of personnel deployments. Moreover, the country has past experience with rapidly deploying Mozambique FELTP residents to Angola to respond to a yellow fever outbreak, and in receiving CDC EIS officers to respond to outbreaks and emergencies in Mozambique. Mozambique is member of AFENET and TEPHINET networks, which help facilitate rapid exchange of personnel in public health emergencies. Access to technical assistance from existing development partners (e.g. WHO, UNICEF, FAO, MSF, CDC) under the leadership of the Government of Mozambique, has been demonstrated in past emergencies (e.g. flood and drought response).

That being said, there are numerous issues. The JEE states that despite ratification of the SADC health agreement, no specific legal or regulatory processes and logistical plans are available to allow for rapid cross-border deployment and receipt of public health and medical personnel during emergencies. Therefore, such agreements should be formalized with neighbouring states within the SADC context. Moreover, there is no comprehensive national plan, nor are there standard operating procedures, for deployment of health personnel during an emergency; the system currently operates on informal agreements. The country has limited personnel that need further competency evaluation by tier, to facilitate deployment. The deployment of competency and health personnel involves many stakeholders which are not adequately coordinated. Therefore, opportunities should be sought to bring together multi-sectorial stakeholders on a periodic basis to plan and coordinate competency and health personnel deployment. ⁵⁹³

Mozambique scored 44 out of 100 in the UHC Service Coverage Index of the World Health Organization (WHO). ⁵⁹⁴ It represents a massive increase since 2000, when it scored 20. ⁵⁹⁵

Moreover, in accordance with Mozambique Expert, "the country's healthcare system faces various obstacles such as limited infrastructure, economic constraints, and a high burden of communicable diseases". ⁵⁹⁶

The report "Health Financing Landscape in Mozambique" (2023), published by the Southern African Development Community (SADC), underscores that "Mozambique’s health system suffers from a number of challenges, including significant inequities in access to services, (…) which suffers from a lack of resources and limited service offering" and that "public facilities generally have poor infrastructure". ⁵⁹⁷ The Mozambican healthcare system also suffers from the shortage of human resources, and low availability of pharmaceutical and clinical consumables". ⁵⁹⁸

Additionally, the Health Policy and its Strategy for Implementation (Resolution No. 13 of 16 April 2021) has a specific objective of offering more and better services adequate for every level of health, ensuring the continuity of services. ⁵⁹⁹

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

There is no evidence of a plan to ensure continuity of essential health services during a public health emergency.

The Health Policy and its Strategy for Implementation (Resolution No. 13 of 16 April 2021) has a specific objective of offering more and better services adequate for every level of health, ensuring the continuity of services. ⁶⁰⁰ However, there is no mention of specific provisions to ensure the continuity of those services during a public health emergency. ⁶⁰¹

The Director Plan for Disaster Risk Reduction 2017-2030 (PDRRD, Plano Director para a Reducção do Risco de Desastres 2017-2030) acknowledged that pandemics and epidemics are within the scope of disasters of the Mozambican legal framework. ⁶⁰² The PDRRD has a strategy to elaborate sectoral plans to ensure the continuity of operations, including the provision of basic services during and after emergencies. ⁶⁰³ However, there is no evidence such plan has been enacted on the websites of the Ministry of Health (MISAU), the National Health Institute (INS) or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ⁶⁰⁴ ⁶⁰⁵ ⁶⁰⁶

In June 2025, the World Bank approved the Mozambique Health Emergency Preparedness, Response and Resilience Project, an initiative to strengthen the health system’s ability to deliver essential services consistently and equitably, with a specific target of underserved and climate-vulnerable areas by investing in human resources, infrastructure, and systems that ensure continuity of care during emergencies. The project seeks to strengthening the health workforce capacity, particularly in high-risk areas, by improving recruitment, training, and retention systems, improving pharmaceutical supply chains by supporting the regulatory agency in bringing more transparency and speed to procurement processes, lowering and standardizing prices of health commodities to ensure access to medicines, particularly during crises; and enhancing disease surveillance and laboratory capacity to improve early warning and response systems to quickly detect and respond to health emergencies like cholera outbreaks or heat waves.

4.1.2 Facilities capacity

4.1.2a Hospital beds per 100,000 people

Score: 15.3

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 100

Mozambique has the capacity to isolate patients with highly communicable diseases in patient isolation rooms and units located within the country.

According to a 2024 World Health Organization (WHO) report on the operational status of the health system in Cabo Delgado Province, there are isolation rooms for patients with highly communicable diseases in the province. ⁶⁰⁷ However, the service is limited, with only 14% of the 115 healthcare units providing it, either fully or partially. ⁶⁰⁸

In 2020, due to the COVID-19 outbreak, the Ministry of Health (MISAU) inaugurated an isolation unit at Polana Caniço General Hospital in Maputo. ⁶⁰⁹ The unit is equipped with beds for initial triage, medical personnel, oxygen supply, and other necessary infrastructure. ⁶¹⁰

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 100

Mozambique has demonstrated capacity to expand isolation capacity in response to an infectious disease outbreak in the past two years.

In August 2024, Mozambique created isolation facilities in Sofala and Maputo to prevent the spread of monkeypox. ⁶¹¹ ⁶¹²

4.2 Supply chain for health system and healthcare workers

4.2.1 Routine health care and laboratory system supply

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 100

Mozambique has a national or international procurement protocol in place which can be used by the Ministries of Health and Agriculture for the acquisition of laboratory supplies and medical supplies for routine needs.

Pursuant to Article 97, Section (j), of the Public Procurement Law (Decree No. 79 of 30 December 2022), presents a streamlined procurement process for health goods, including from foreign producers, in case of public health emergencies. ⁶¹³ As per Article 2, Section (1), the Public Procurement Law is applicable to any sector, including the Ministry of Health and the Ministry of Agriculture, the Environment, and Fisheries. ⁶¹⁴

In addition, the Centre for Medicine and Medical Goods (CMAM), established under Decree No. 13/75 of 6 September 1975, is responsible for the administration, coordination, and execution of functions relating to the acquisition, storage, conservation, and distribution of medicines and chemical products, pharmaceutical specialities, dressings, medical supplies, laboratory reagents, medical equipment, and surgical materials, as set out in Article 2. ⁶¹⁵ In accordance with Article 8, CMAM is further responsible for the procurement of medicines, dressings, medical supplies, chemical reagents, radiology films, medical equipment, surgical materials, among others. ⁶¹⁶

According to its official website, CMAM is responsible for ensuring a regular and continuous supply of essential medicines and vital health products for users of the National Health System. ⁶¹⁷ The Distribution Department approves requisitions from CMAM’s Direct Clients (Provincial Medicine Warehouses, Central Hospitals, and Intermediate Warehouses), subsequently issuing Supply Orders to Central/Regional Warehouses. These warehouses then distribute medicines and related products to Provincial Medicine Warehouses, Intermediate Warehouses, and Central Hospitals, which in turn are responsible for supplying their own clients (District Medicine Warehouses and Provincial, General, District, and Rural Hospitals). ⁶¹⁸

4.2.2 Stockpiling for emergencies

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 0

There is no evidence Mozambique has a stockpile of medical supplies for national use during a public health emergency. Moreover, Mozambique does not have an overarching national public health emergency response plan.

On 14 June 2023, the Ministry of Health (MISAU) issued a directive establishing the Public Health Emergency Committee (CESP, Comité de Emergências de Saúde Pública no Ministério da Saúde). ⁶¹⁹ Pursuant to Article 3, CESP is tasked with coordinating, overseeing, and monitoring preparedness, response, and recovery efforts related to public health emergencies. ⁶²⁰ In accordance with Article 4, Section 1, Subsection (d), CESP is also responsible for approving public health emergency plans and overseeing their implementation. ⁶²¹

In May 2022, MISAU, through the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde) and the National Directorate of Public Health (DNSP), a workshop to update the National Action Plan for Health Security (PNASS, Plano Nacional de Acção para Segurança Sanitária) for 2023-2027. ⁶²² According to the INS, the discussions around PNASS for 2023-2027 covered multiple threat types, such as antimicrobial resistance, zoonotic diseases, and others. ⁶²³ However, there is no evidence that PNASS has been published on the websites of MISAU, INS or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ⁶²⁴ ⁶²⁵ ⁶²⁶

Mozambique has not submitted a National Action Plan for Health Security (NAPHS) before the World Health Organization (WHO). ⁶²⁷

The World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016) recommended that Mozambique "finalize the multi-hazard public health emergency preparedness and response plan, (…) [which] should address both human and animal health sectors, consistent with a One Health approach, and should include monitoring and evaluation components". ⁶²⁸ Moreover, the JEE states that "Mozambique has a limited capacity for medical countermeasures, and there is no emergency medical stockpile", and there "there is no formalized national plan, or stockpile with budget" for rapid deployment of medical countermeasures or non-medical commodities. ⁶²⁹

Nevertheless, the United States Agency for International Development (USAID), through the Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project, provides technical and operational assistance to MISAU Central Medical Stores (CMAM), the Central Laboratory Department, and Provincial Warehouses to manage the country's supply chain. ⁶³⁰ However, it states that MISAU "has faced a host of challenges, including limited capacity due to poor storage infrastructure, deficient management information systems, a lack of trained logistics professionals, low staff motivation due to poor wages and working conditions, lack of options for transporting goods, poor implementation of supply chain procedures, lack of involvement of clinical staff in managing medicines, and lack of inventory management at the health facility level.". ⁶³¹

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There is no evidence Mozambique has a stockpile of laboratory supplies (e.g. reagents, media) for national use during a public health emergency.

On 14 June 2023, the Ministry of Health (MISAU) issued a directive establishing the Public Health Emergency Committee (CESP, Comité de Emergências de Saúde Pública no Ministério da Saúde). ⁶³² Pursuant to Article 3, CESP is tasked with coordinating, overseeing, and monitoring preparedness, response, and recovery efforts related to public health emergencies. ⁶³³ In accordance with Article 4, Section 1, Subsection (d), CESP is also responsible for approving public health emergency plans and overseeing their implementation. ⁶³⁴

In May 2022, MISAU, through the National Health Institute of Mozambique (INS, Instituto Nacional de Saúde) and the National Directorate of Public Health (DNSP), a workshop to update the National Action Plan for Health Security (PNASS, Plano Nacional de Acção para Segurança Sanitária) for 2023-2027. ⁶³⁵ According to the INS, the discussions around PNASS for 2023-2027 covered multiple threat types, such as antimicrobial resistance, zoonotic diseases, and others. ⁶³⁶ However, there is no evidence that PNASS has been published on the websites of MISAU, INS or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ⁶³⁷ ⁶³⁸ ⁶³⁹

Mozambique has not submitted a National Action Plan for Health Security (NAPHS) before the World Health Organization (WHO). ⁶⁴⁰

The World Health Organization's (WHO) Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique (2016) recommended that Mozambique "finalize the multi-hazard public health emergency preparedness and response plan, (…) [which] should address both human and animal health sectors, consistent with a One Health approach, and should include monitoring and evaluation components". ⁶⁴¹ Moreover, the JEE states that "there is no emergency medical stockpile", and there "there is no formalized national plan, or stockpile with budget" for rapid deployment of medical countermeasures or non-medical commodities. ⁶⁴²

Nevertheless, the United States Agency for International Development (USAID), through the Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project, provides technical and operational assistance to MISAU Central Medical Stores (CMAM), the Central Laboratory Department, and Provincial Warehouses to manage the country's supply chain. ⁶⁴³ However, it states that MISAU "has faced a host of challenges, including limited capacity due to poor storage infrastructure, deficient management information systems, a lack of trained logistics professionals, low staff motivation due to poor wages and working conditions, lack of options for transporting goods, poor implementation of supply chain procedures, lack of involvement of clinical staff in managing medicines, and lack of inventory management at the health facility level.". ⁶⁴⁴

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no evidence Mozambique conducts or requires an annual review of the national stockpile to ensure the supply is sufficient for a public health emergency.

There is no evidence such requirement on the official websites of the Ministry of Health (MISAU), the National Health Institute (INS), or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ⁶⁴⁵ ⁶⁴⁶ ⁶⁴⁷

Nevertheless, the Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program in Mozambique reports that it supported the country to produce an emergency supply chain management strategy and key interventions, such as data collection and reporting system to inform decisions on infection prevention and control (IPC), generate a weekly stock status report and update the COVID-19 commodities supply plan with it to meet the changing needs of the pandemic, and form provincial-level technical working groups to coordinate emergency supply chain activities, facilitating responsive stock management at the local level. ⁶⁴⁸ However, there is no evidence that it is either required or conducted annually. ⁶⁴⁹

4.2.3 Manufacturing and procurement for emergencies

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 100

Mozambique has a mechanism to procure medical supplies for national use during a public health emergency.

Pursuant to Article 16 of the Mozambican Medicine Law (Law No. 12 of 8 September 2017, in cases of public health emergencies, such as disease outbreaks, natural disasters, or stock ruptures, the Minister of Health may authorise the special or emergency importation of medicines, vaccines, biological products, and other health-related items without prior licensing. ⁶⁵⁰ These imports are subject to a simplified registration procedure. ⁶⁵¹

Moreover, the Public Procurement Law (Decree No. 79 of 30 December 2022), in Article 97, established a procurement modality known as Direct Adjustment, which allows for the expedited acquisition of medical equipment, medicine or medical supplies for the health sector in cases of emergency, or when failure to procure such goods could result in irreparable harm to the State or to society. ⁶⁵²

Additionally, pursuant to Articles 31 and 106 of the Public Procurement Law, medical goods from foreign producers intended for public health emergencies may be exempt from the standard qualification requirements applicable to public procurement processes, with the only exception being the requirement to provide proof that the supplier is not subject to bankruptcy proceedings. ⁶⁵³

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 100

Mozambique has a mechanism to procure medical supplies for national use during a public health emergency.

Pursuant to Article 16 of the Mozambican Medicine Law (Law No. 12 of 8 September 2017, in cases of public health emergencies, such as disease outbreaks, natural disasters, or stock ruptures, the Minister of Health may authorise the special or emergency importation of medicines, vaccines, biological products, and other health-related items without prior licensing. ⁶⁵⁴ These imports are subject to a simplified registration procedure. ⁶⁵⁵

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

Mozambique has a mechanism for national and subnational levels for emergency logistics and supply chain management. The mechanism cover specific considerations such as cold chain management for vaccines.

The Emergency Supply Chain Manual (Manual-CAE) is a platform launched in September 2021 as part of Mozambique’s preparedness framework for public health emergencies. ⁶⁵⁸ The platform comprises several tools, including a user guide, standard operating procedures for disease outbreak response, and a quick response guide. It is designed to function as a readiness system established prior to an emergency, enabling the management of all products, materials, and supplies necessary to respond effectively to health outbreaks. ⁶⁵⁹ The initiative falls under the One Health framework and is managed by the National Health Institute (INS). ⁶⁶⁰ ⁶⁶¹ The platform was funded by the United States Agency for International Development (USAID). ⁶⁶²

In March 2022, the Global Health Supply Chain Program (GHSC) and the INS held a meeting to assess progress related to the implementation of the Manual-CAE. ⁶⁶³ However, there have been no further updates published on the official websites of the Ministry of Health or the INS. ⁶⁶⁴ ⁶⁶⁵ However, no further detailed information about the platform’s content, tools, or operational status is publicly available online. ⁶⁶⁶ ⁶⁶⁷

According to the Joint External Evaluation (JEE) conducted in 2016, the national cold chain inventories are undertaken every three years, and based on the assessment, equipment is allocated in districts and health facilities, and over 80% of health facilities have functional cold chain equipment. ⁶⁶⁸ Moreover, Mozambique outlines plans to create regional vaccine warehouses, provides refrigerated trucks for vaccine distribution, and three mobile cold chain maintenance units at sub-national level, as well as installing temperature monitoring devices, cold chain spare parts, and training of cold chain maintenance technicians at provincial level and cold chain maintenance assistance at district level. ⁶⁶⁹

4.3 Medical countermeasures and personnel deployment

4.3.1 System for dispensing MCMs during a public health emergency

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 100

Mozambique has guidelines in place for dispensing medical countermeasures (MCM) for national use during a public health emergency (i.e., antibiotics, vaccines, therapeutics and diagnostics).

The Emergency Supply Chain Manual (Manual-CAE) is a platform launched in September 2021 as part of Mozambique’s preparedness framework for public health emergencies. ⁶⁷⁰ The platform comprises several tools, including a user guide, standard operating procedures for disease outbreak response, and a quick response guide. It is designed to function as a readiness system established prior to an emergency, enabling the management of all products, materials, and supplies necessary to respond effectively to health outbreaks. ⁶⁷¹ The initiative falls under the One Health framework and is managed by the National Health Institute (INS). ⁶⁷² ⁶⁷³ The platform was funded by the United States Agency for International Development (USAID). ⁶⁷⁴

In March 2022, the Global Health Supply Chain Program (GHSC) and the INS held a meeting to assess progress related to the implementation of the Manual-CAE. ⁶⁷⁵ However, there have been no further updates published on the official websites of the Ministry of Health or the INS. ⁶⁷⁶ ⁶⁷⁷ However, no further detailed information about the platform’s content, tools, or operational status is publicly available online. ⁶⁷⁸ ⁶⁷⁹

4.3.2 System for receiving foreign health personnel during a public health emergency

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 0

There is no evidence Mozambique has a public plan in place to facilitate workforce surge in an emergency.

The Health Policy and its Strategy for Implementation, enacted through Resolution No. 13 of 16 April 2021, does not have provisions related to the facilitation of workforce surge in an emergency. ⁶⁸¹

The National Plan for Development of Human Resource for Health 2008-2015 (PNDRHS), enacted in 2008, has measures to increase the number of healthcare professionals in Mozambique, such as increased recruitment of recently graduated doctors and nurses, and others. ⁶⁸² However, there is no mention of the facilitation of workforce surge during an emergency. ⁶⁸³ Additionally, according to the Joint External Evaluation, the PNDRHS has not been updated or review, mentioning that "periodic review is needed of the human resource plan to ensure that it meets the health needs of the country". ⁶⁸⁴

The National Plan for the Development of Human Resources for the Health Sector 2016-2025 (2016) (PNDRHS), enacted by the Ministry of Health (MISAU), provides an analysis of the situation of human resources for the health sector in Mozambique, identifies the key objectives and indicators which includes estimates and forecasts for the health sector labour market as well as strategies to develop and grow health workers in Mozambique. ⁶⁸⁵ The PNDRHS explicitly mentions shortcomings of labour, notably in the field of surgical teams (instrumentalists and anaesthesiologists) (p. 59). ⁶⁸⁶ However, there is no mention of measures to facilitate workforce surge during healthcare emergencies. ⁶⁸⁷

There is no evidence such plan on the official websites of the Ministry of Health (MISAU), the National Health Institute (INS) or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ⁶⁸⁸ ⁶⁸⁹ ⁶⁹⁰

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no evidence Mozambique has a plan in place to receive health personnel from other countries to respond to a public health emergency.

According to WHO's "Joint External Evaluation of IHR Core Capacities of the Republic of Mozambique" (2016), "Mozambique is member of AFENET and TEPHINET networks, which help facilitate rapid exchange of personnel in public health emergencies". ⁶⁹¹ However, it underscores that "for health personnel deployment, formal procedures and human asset typing are also lacking", even though "several recent examples of successfully receiving and sending technical experts to rapidly respond to public health emergencies demonstrate country capacity in this area", particularly referring to the contexts of "pandemic influenza and Ebola preparedness, which partially addressed issues of medical countermeasures and health personnel deployment." ⁶⁹² The document underscores that Mozambique had rapidly deployed healthcare personnel to Angola to respond to a yellow fever outbreak, and it received CDC EIS officers to respond to outbreaks and emergencies in Mozambique. ⁶⁹³

Law No. 3 of 10 February 2022, which sets forth provisions for disease control and prevention, does not contain provisions to receive health personnel from other countries during public health emergencies. ⁶⁹⁴ There is no evidence that it is part of a plan, particularly on the official websites of the Ministry of Health (MISAU), the National Health Institute (INS) or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ⁶⁹⁵ ⁶⁹⁶ ⁶⁹⁷

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is no evidence Mozambique has a public plan in place to redeploy existing health personnel within the country.

The Health Policy and its Strategy for Implementation, enacted through Resolution No. 13 of 16 April 2021, does not have provisions related to the redeploy of existing health personnel. ⁶⁹⁸

The National Plan for Development of Human Resource for Health 2008-2015 (PNDRHS), enacted in 2008, has measures to increase the number of healthcare professionals in Mozambique, such as increased recruitment of recently graduated doctors and nurses, and others. ⁶⁹⁹ However, there is no mention of the redeploy of existing health personnel. ⁷⁰⁰ Additionally, according to the Joint External Evaluation, the PNDRHS has not been updated or review, mentioning that "periodic review is needed of the human resource plan to ensure that it meets the health needs of the country". ⁷⁰¹

The National Plan for the Development of Human Resources for the Health Sector 2016-2025 (2016) (PNDRHS), enacted by the Ministry of Health (MISAU), provides an analysis of the situation of human resources for the health sector in Mozambique, identifies the key objectives and indicators which includes estimates and forecasts for the health sector labour market as well as strategies to develop and grow health workers in Mozambique. ⁷⁰² The PNDRHS explicitly mentions shortcomings of labour, notably in the field of surgical teams (instrumentalists and anaesthesiologists) (p. 59). ⁷⁰³ However, there is no mention of measures to redeploy existing health personnel within the country. ⁷⁰⁴

There is no evidence such plan on the websites of the Ministry of Health (MISAU), the National Health Institute (INS) or the Mozambique National Gazette (INM, Imprensa Nacional de Moçambique). ⁷⁰⁵ ⁷⁰⁶ ⁷⁰⁷

4.4 Healthcare access

4.4.1 Access to healthcare

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 75

The Constitution of Mozambique explicitly guarantees citizens' right to medical care.

The Constitution of the Republic of Mozambique (2004) enshrines the right to health in Article 89, establishing that every citizen is entitled to healthcare. ⁷⁰⁸ Additionally, Article 116 mandates the State to promote and ensure the expansion of equal access to healthcare for all citizens. ⁷⁰⁹ However, the Constitution does not explicitly state that healthcare is guaranteed free of charge. ⁷¹⁰

4.4.1b Access to skilled birth attendants (% of population)

Score: 52.94

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 99.28

4.4.1d Coverage of essential health services through universal health coverage

Score: 35.42

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 77.69

4.4.1f Rate of mortality amenable to health care

Score: 78.29

4.4.2 Paid medical leave

4.4.2a Guaranteed paid sick leave

Score: 66.67

In Mozambique, workers are guaranteed paid sick leave. However, there is no mention that is covers mental health problems.

Pursuant to Article 112, Section 3, Subsection (d) of the Labour Law (Law No. 13 of 25 August 2023), workers in Mozambique are entitled to paid sick leave. ⁷¹¹ Article 113 stipulates that if an employee is absent due to illness for a continuous period exceeding 15 days, the employer may refer the worker to a Medical Board (Junta de Saúde) or another licensed entity to assess the employee's work capacity. ⁷¹² Additionally, the employer may, either on their own initiative or at the request of the employee, submit workers to such evaluations if their productivity appears to be affected by health reasons or if they record more than five days of sick leave per quarter. ⁷¹³

4.4.3 Healthcare worker access to healthcare

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

The Government of Mozambique has not enacted legislation committing to provide prioritized healthcare services to healthcare workers who become sick as a result of responding to a public health emergency.

Pursuant to article 24 of Decree No. 51 of 1 July 2020, which approved administrative measures for the prevention and containment of the COVID-19 pandemic, health professionals, health agents, and all workers who, by the nature of their functions, provide public-facing services “deserve special treatment.” ⁷¹⁴ However, the decree does not specify what such treatment entails. ⁷¹⁵

Moreover, Mozambique enacted Decree No. 46 of 24 June 2020, which established a 30% risk allowance for healthcare professionals assigned to health units, laboratories, health research facilities, hospital waste management, sterilization, radiology, radiotherapy, hospital maintenance, pathology, and morgue services. ⁷¹⁶

4.5 Communications with healthcare workers during a public health emergency

4.5.1 Communication with healthcare workers

4.5.1a Existence of system for communication during a public health emergency

Score: 100

Mozambique has a system in place for public health officials and healthcare workers to communicate during an emergency.

The Health Emergency Information System (SIE), managed by the National Health Institute (INS), is a platform that serves as an official source for the provision of data and information that can be used by society in order to ensure better monitoring of the evolution of outbreaks and epidemics that plague the country. In addition, it represents a mechanism for obtaining necessary and timely information to implement decision-making processes in various domains. ⁷¹⁷ ⁷¹⁸ However, there is no information on SIE's date of establishment. ⁷¹⁹ ⁷²⁰

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

There is no evidence the system for public health officials and healthcare workers to communicate during an emergency in Mozambique encompass healthcare workers in both the public and private sector.

The Health Emergency Information System (SIE), managed by the National Health Institute (INS), is a platform that serves as an official source for the provision of data and information that can be used by society in order to ensure better monitoring of the evolution of outbreaks and epidemics that plague the country. In addition, it represents a mechanism for obtaining necessary and timely information to implement decision-making processes in various domains. ⁷²¹ However, there is no mention it encompasses healthcare workers from the private sector. ⁷²² ⁷²³

4.6 Infection control practices

4.6.1 Healthcare-associated infection (HCAI) monitoring

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is no evidence that the national public health system in Mozambique is monitoring for and tracking the number of healthcare associated infections (HCAI) that take place in healthcare facilities.

According to the Joint External Evaluation (JEE) conducted in 2016, the guidelines outlined in the Reference Manual have been implemented since 2014. At the time of the assessment, 300 healthcare facilities, including 55 hospitals and 245 health centers, were conducting at least one basic component of the national IPC program. ⁷²⁴ HCAI special components are also implemented in some facilities, such as prevention of infection related to the use of intravascular catheters; prevention of urinary infections related to the use of civets; prevention of health care associated pneumonia, and prevention of surgical wound infections. ⁷²⁵ Moreover, it also stated that Guidelines have been developed on safety, hygiene and health at work for the national health system, and for the control of healthcare associated infections. ⁷²⁶ However, there is no mention that the data has been published. ⁷²⁷

Moreover, there is no further evidence of such monitoring and tracking on the official websites of the Ministry of Health, the National Health Institute, or the National Statistics Institute (INE). ⁷²⁸ ⁷²⁹ ⁷³⁰

4.6.1b Infection prevention and control programme

Score: 100

Mozambique has an infection prevention and control program in place nationally.

Since 2004, the Ministry of Health of Mozambique has implemented infection prevention and control (IPC) measures across healthcare facilities nationwide. ⁷³¹ In 2009, the Ministry formally established a National IPC Program, which introduced standardized protocols covering hand hygiene, use of gloves, personal protective equipment (PPE), and other critical practices. ⁷³² However, there is no evidence that the full IPC program is publicly available online. ⁷³³ ⁷³⁴ ⁷³⁵

In 2014, the Ministry published the Reference Manual: IPC in Healthcare Units, which provides detailed guidelines for preventing infections, including proper use of PPE, sterilization procedures, hygiene protocols, safe handling of sharp objects (objetos de perfurocortantes), safe injection practices, and additional preventive measures. ⁷³⁶

Moreover, according to The Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, MTaPS, in partnership with Mozambique, established IPC training teams in all 11 provinces and capacitated 74 master trainers, who cascaded the training to thousands of health care workers by October 2020, and improved IPC compliance at 21 COVID-19 centers and 96 health facilities, innovating use of a facility-level IPC scorecard adapted from the WHO checklist to assess a facility’s IPC performance and create performance improvement plans. ⁷³⁸

4.6.1c National plan to ensure a safe environment in health facilities

Score: 0

There is no evidence of a plan to ensure a safe environment in health facilities nationally in Mozambique.

The Strategic Plan for the Health Sector (PESS) 2020-2024, published in August 2022 by the Ministry of Health (MISAU), does not include provisions to ensure a safe environment in health facilities nationally. [1

4.7 Capacity to test and approve new medical countermeasures

4.7.1 Regulatory process for clinical trials of unregistered interventions

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

There is a national requirement in Mozambique for ethical review before beginning a clinical trial.

Pursuant to Article 5, Section (2), of the Regulation for Clinical Trials (Decree No. 17 of 27 April 2023), authorization to conduct clinical trials involving human subjects requires prior approval from the National Health Bioethics Committee (CNBS). ⁷³⁹ In accordance with Article 7, Section (1), Subsection (b), ethical approval is a prerequisite for authorization to start clinical trials. ⁷⁴⁰ Furthermore, the results of such trials may only be disclosed after approval by the CNBS (Article 9). ⁷⁴¹ As established in Article 35, Section (b), conducting clinical trials involving humans without prior authorization from the CNBS may result in financial penalties of up to 1,000 minimum wages, without prejudice to any civil, criminal, or disciplinary liability. ⁷⁴²

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 0

Mozambique does not have an expedited process for approving clinical trials for unregistered medical countermeasures (MCM) or mutual recognition of clinical trials results taking place elsewhere to treat ongoing pandemics or epidemics.

Pursuant to Article 16 of the Medicine Law (Law No. 12 of 8 September 2017), in cases of emergencies, the Ministry of Health can authorize the importation of medicine, vaccines, biological and health products. ⁷⁴³ This includes cases of public health emergencies, natural disasters, and clinical trials and research. ⁷⁴⁴ However, clinical trials are still subject to prior approval by the National Authority of Medicine Regulation (ANARME) based on the protocols established by Mozambique, as per Article 16, Section 3. ⁷⁴⁵

The Regulation for Clinical Trials (Decree No. 17 of 27 April 2023) does not present provisions on the simplified approval of MCM or mutual recognition of clinical results to treat ongoing pandemics or epidemics. ⁷⁴⁶

4.7.2 Regulatory process for approving medical countermeasures

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

In Mozambique, there is a government agency responsible for approving new medical countermeasures (MCM) for humans.

Pursuant to Article 5, Section 2, of the Regulation for Clinical Trials (Decree No. 17 of 27 April 2023), the approval of MCM for humans is under the remit of National Authority of Medicine Regulation (ANARME). ⁷⁴⁷

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 100

Mozambique has an expedited process for approving medical countermeasures (MCM) for human use during a public health emergency.

Commitment to International Norms

5.1 IHR reporting compliance and disaster risk reduction

5.1.1 Official IHR reporting

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Mozambique has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁷⁵⁰

5.1.2 Integration of health into disaster risk reduction

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 100

Mozambique has integrated epidemics and pandemics into the national risk reduction strategy.

Pursuant to Article 1, Section h, of Law No. 10 of 24 August 2020 (Disaster Risk Reduction and Management Law), epidemics and pandemics are included in disaster reduction and management strategies. ⁷⁵¹ In accordance with Article 26, Section 2, Subsection d, government entities should adopt measures to enhance surveillance systems to control the spread of diseases and epidemics caused by vectors due to climate change. ⁷⁵²

The Director Plan for Disaster Risk Reduction 2017-2030 (PDRRD, Plano Director para a Reducção do Risco de Desastres 2017-2030) acknowledged that pandemics and epidemics are within the scope of disasters of the Mozambican legal framework. ⁷⁵³ The PDRRD presents measures to identify partnerships with UN agencies, elaborate databases about civil society organizations that operate in the disaster reduction sector, and others. ⁷⁵⁴ However, there is no mention of specific measures related to epidemics and pandemics, even though they are covered as disasters. ⁷⁵⁵

5.2 Cross-border agreements on public health and animal health emergency response

5.2.1 Cross-border agreements

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 100

Mozambique is part of a regional group with provisions on public health emergencies.

Mozambique has been a member of the African Union since 18 July 1975. ⁷⁵⁶ On 15 July 2022, the African Union published its Revised Statute of the African CDC and its Framework of Operation; pursuant to Article 3, Member States will receive support to the implementation of early warning and response surveillance platforms, as well as preparedness and response systems, declare Public Health Emergency of Continental Security (PHECS), promote partnerships and collaborations among Member States to address emerging and endemic diseases, pandemics, and public health emergencies, implement capacity-building measures in public health, including through medium- and long-term leadership, field epidemiological, public health emergency and laboratory training programs, and others. ⁷⁵⁷

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 50

Mozambique has cross-border strategies, as part of a regional group, with regards to animal health emergencies.

Mozambique has been a member of the African Union since 1975. ⁷⁵⁸ In 2019, the African Union Interafrican Bureau for Animal Resources (AU-IBAR) enacted the Animal Health Strategy for Africa 2019-2035, which includes the goal of promoting the establishment of early warning, emergency response mechanisms and disaster fund for animal resources at national, regional and continental levels. ⁷⁵⁹ It includes goals to adapt emergency preparedness and response framework guidelines, train and simulate exercises at regional and national levels, establish regional response teams and mechanism, and establish a continental-level disaster fund. ⁷⁶⁰ Nevertheless, there is no evidence that such measures have been implemented on the African Union website. ⁷⁶¹

Additionally, Mozambique signed the Southern African Development Community (SADC) Protocol on Health in 1999 that includes several health-related issues, including public health emergencies. ⁷⁶² ⁷⁶³ However, the document does not include measures related to animal health emergencies. ⁷⁶⁴ The World Organisation for Animal Health (WOAH) Veterinary Legislation Identification Mission Report (2015) underscores that Mozambique has not signed a Declaration of Animal Disease Emergency or created an Animal Disease Emergency Fund. ⁷⁶⁵

In addition, the SADC and the WOAH signed a memorandum of understanding (MOU) in 2024 pertaining to cooperation between the bodies, including in animal health with regular exchange of information. ⁷⁶⁶

The Phytosanitary and Animal Health Report (2021), published by the Ministry of Agriculture and Rural Development, states that Mozambique follows WOAH standards to facilitate safe trade of animals and animal products, and that the country participates in the Locust Control Organisation for Central and Southern Africa (IRCLO-CSA), alongside Tanzania, Malawi, Zambia, Zimbabwe, and Kenya, aimed at controlling migratory pests like the red locust. ⁷⁶⁷ Moreover, the country adhered to SADC and the African Union Interafrican Bureau for Animal Resources (AU-IBAR) protocols on animal health, which demand solidatiry and transparency in reporting animal events. ⁷⁶⁸ However, there are no details on its implementation. ⁷⁶⁹

5.3 International commitments

5.3.1 Participation in international agreements

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Mozambique has ratified the Biological Weapons Convention.

The country ratified through accession the Biological Weapons Convention on 29 March 2011 before the United Kingdom. ⁷⁷⁰

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 100

Mozambique has submitted confidence building measures for the Biological Weapons Convention in the past three years. ⁷⁷¹

The latest submission for Mozambique dates of 15 April 2025. ⁷⁷²

5.3.1c Submission of UNSCR 1540 reports

Score: 100

Mozambique has provided the required United Nations Security Council Resolution (UNSCR) 1540 report to the Security Council Committee established pursuant to resolution 1540 (1540 Committee).

THe country submitted the required document on 22 November 2021. ⁷⁷³

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 0

5.3.2 Voluntary memberships

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

Mozambique is not part of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (GP), the Australia Group, or the Proliferation Security Initiative (PSI).

Mozambique is not a member in the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction. ⁷⁷⁴ Mozambique is not a member in the Australia Group (AG) or the Proliferation Security Initiative (PSI) either. ⁷⁷⁵ ⁷⁷⁶

5.4 JEE and PVS

5.4.1 Completion and publication of a JEE assessment and gap analysis

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 0

Mozambique has not completed a Joint External Evaluation (JEE) and published a full public report in the last five years.

Mozambique conducted a WHO Joint External Evaluation (JEE) and published a full public report in 2016. ⁷⁷⁷

5.4.2 Completion and publication of a PVS assessment and gap analysis

5.4.2a Completion and publication of PVS report (past five years)

Score: 100

Mozambique has completed and published a Performance of Veterinary Services (PVS) assessment in the last five years.

Mozambique published a follow-up evaluation report of the Aquatic Animal Health Services in Mozambique in 2023. ⁷⁷⁸

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

Mozambique has not completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years.

Mozambique published a follow-up evaluation report of the Aquatic Animal Health Services in Mozambique in 2023. ⁷⁷⁹ Before that, it published a VLSP Identification Mission (2015) and an Evaluation of Performance of Aquatic Animal Health Services (2011). ⁷⁸⁰

5.5 Financing

5.5.1 National financing for epidemic preparedness

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 0

Mozambique has not allocated national funds to improve capacity to address pandemic or epidemic threats within the past three

The State Budget Law for 2025 (Law No. 2 of 26 May 2025) set aggregate spending by function and institution, but there is no evidence it has specific funding for improving capacity to address pandemic or epidemics. ⁷⁸¹ For 2025, Mozambique reduced investment in the health sector and failed to allocate 15% of the budget to the sector, as stipulated in the Abuja Declaration, to which non-governmental organizations warned of "a scenario of chronic underfunding, reduction in vital investments, and persistent structural fragility, which could compromise citizen's right to health". ⁷⁸²

There is no evidence of allocation of national funds specifically for improving capacity to address pandemic or epidemic threats on the official websites of the Ministry of Health or the Ministry of Economics and Finance. ⁷⁸³ ⁷⁸⁴

5.5.2 Financing under JEE and PVS reports and gap analyses

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 0

The Joint External Evaluation (JEE) report for Mozambique (2016) and the National Action Plan for Health Security (NAPHS) do not allocate or describe specific funding from the national budget to address identified gaps.

The JEE Mozambique, published in 2016, highlights that "adequate and consistent financial resources are required for essential biosafety and biosecurity activities", but gives no figures, schedules, or budget references. ⁷⁸⁵ It underscores that "there is no formalized national plan, or stockpile with budget, exists for rapid deployment of medical countermeasures or non-medical commodities". ⁷⁸⁶

Moreover, NAPHS Mozambique (2017) does not include provisions related to the allocation or specific funding from the national budget to address identified gaps. ⁷⁸⁷ ⁷⁸⁸

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

The Performance of Veterinary Services (PSV) assessment in Mozambique does not allocate or describe specific funding from the national budget to address the identified gaps.

Mozambique published a follow-up evaluation report of the Aquatic Animal Health Services in Mozambique in 2023. ⁷⁸⁹ Before that, it published a VLSP Identification Mission (2015) and an Evaluation of Performance of Aquatic Animal Health Services (2011). ⁷⁹⁰

The follow-up evaluation states that funding for the national aquatic laboratory system is insufficient for a sustainable system, and underscores a seven-year government freeze on hiring, but gives no costed plan or fiscal commitment to overturn the situation. ⁷⁹¹ The VLSP Identification Mission and the Evaluation of Performance do not set out allocation or describe funding from the national budget to address the identified gaps. ⁷⁹² ⁷⁹³

5.5.3 Financing for emergency response

5.5.3a Emergency public financing during a public health emergency

Score: 100

Mozambique has emergency public funding that the country can access in the face of a public health emergency.

The Disaster Management Fund (FGC, Fundo de Gestão de Calamidades), established by Decree No. 62 of 25 November 2022, allows the government to mobilize domestic resources in response to officially declared emergencies. ⁷⁹⁴ Pursuant to Article 2, Section 2, Subsection 2, FGC funding are exclusively dedicated to reinforce preparedness, response, recovery and reconstruction associated with calamities. ⁷⁹⁵ In accordance with, Article 1, Section h, of Law No. 10 of 24 August 2020 (Disaster Risk Reduction and Management Law), epidemics and pandemics are included in the list of disasters. ⁷⁹⁶

In 2025, the World Bank approved the Mozambique Contingent Emergency Response Project (CERP), which allows to expenditures related to emergency response to be financed with funds repurposed through the Rapid Response Option (RRO). ⁷⁹⁷ According to the World Bank, "the CERP has a duration of six years and does not have any committed funding at approval. Within the CERP period, it can be activated multiple times, depending on the occurrence of eligible emergencies and the availability of funds. Funds repurposed from Mozambique’s portfolio of active operations will be channeled through the CERP for emergency response". ⁷⁹⁸

5.5.4 Accountability for international commitments to address epidemic threats

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 100

Mozambican senior leaders have made public commitments in the past three years to improve the country's domestic capacity to address pandemic or epidemic threats by expanding financing or requesting support to improve capacity.

In 2023, then President Filipe Nyusi called for fair, predictable and secure mechanisms to facilitate access to financing", and stated that "ensuring domestic and global investments to strengthen the resilience of health systems, the obligation to strengthen mechanisms of international cooperation and coordination for a rapid and efficient response to public health emergencies, are other lessons taught by the pandemic". ⁷⁹⁹

In 2024, the Ministry of Health underscored that Mozambique would "continue to work closely with our partners to improve the health of Mozambicans and to achieve the ambitious goals set out in these new grants", in the context of Global Fund's grants to Mozambique, including a stand-alone grant for pandemic preparedness. ⁸⁰⁰

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

Mozambique has received financing and technical support from donors to improve the country's domestic capacity to address epidemic threats in the past three years. However, there is no evidence of providing other countries with financing or technical support to improve their capacity to address epidemic threats.

In February 2025, Mozambique received financial support from the African Center for Disease Control (CDC) to purchase equipment and implement training programs within the scope of the operationalization of regional centers of excellence. ⁸⁰¹

In June 2025, the World Bank announced the approval of a USD 201 million investment in Mozambique to strengthen the country's health response system against calamities, including epidemics. ⁸⁰²

In April 2024, Mozambique received a USD 789.3 million funding from the World Fund to combat malaria, HIV and tuberculosis, referred to as "epidemics", as well as to strengthen the national health system. ⁸⁰³

However, there is no evidence of funding for other countries on the official websites of the Ministry of Health, the National Health Institute, the Ministry of Economics and Finance, or the Ministry of Foreign Affairs and Cooperation. ⁸⁰⁴ ⁸⁰⁵ ⁸⁰⁶ ⁸⁰⁷

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 100

Mozambique has fulfilled its full contribution to the WHO within the past two years.

According to the latest available statement of the World Health Organization (January 2025), Mozambique has paid its assessed contributions for 2024 and 2025. ⁸⁰⁸ In 2024 and 2025, the assessed contributions amounted to USD 45,940, in which each year the country paid USD 22,970. ⁸⁰⁹ Mozambique is up to date with payments for previous years (2022-2023). ⁸¹⁰

5.6 Commitment to sharing of genetic & biological data & specimens

5.6.1 Commitment to share data and specimens in emergency/non-emergency research

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

There is no evidence Mozambique has a plan or policy for sharing genetic data, clinical specimens, and isolated specimens (biological materials) along with the associated epidemiological data with international organizations and other countries that go beyond influenza.

Decree No. 71 of 28 November 2014 presents biosafety regulations concerning genetically modified organisms (GMOs); however, there is no mention of sharing genetic data with international organizations and other countries. ⁸¹¹ Pursuant to Article 71, the National Biosecurity Authority (ANB) must provide free access to the public on relevant information. ⁸¹² However, there is no policy of plan related to it. ⁸¹³

The Health Policy and its Strategy for Implementation, enacted through Resolution No. 13 of 16 April 2021, does not present measures related to sharing genetic data, clinical specimens, or isolated specimens. ⁸¹⁴

There is no evidence of such plan or policy on the websites of the Ministry of Health, the National Health Institute, the Ministry of Economics and Finance, or the Ministry of Foreign Affairs and Cooperation. ⁸¹⁵ ⁸¹⁶ ⁸¹⁷ ⁸¹⁸

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

There is no evidence that Equatorial Guinea has not shared samples in accordance with the PIP framework in the past two years.

There is no evidence that Equatorial Guinea failed to share samples in accordance with the PIP framework on the Advisory Group Annual Report fo the Director -General (2024). ⁸¹⁹ There is no evidence that the country failed to share samples on the official website of the World Health Organization (WHO). There is no evidence on the Pandemic Influenza Preparedness Framework: Annual Progress report, 1 January – 31 December 2024 (2025) either.

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

Mozambique has shared pandemic pathogen samples during an outbreak in the past two years.

In 2023, the National Directorate for Livestock Development in Mozambique was notified of a suspected outbreak of avian influenza in commercial layers – the Mozambican government shared samples of H7N6 avian influenza with the World Organization for Animal Health (WOAH), the Food and Agriculture Organization (FAO), and the European Union Reference Laboratory for Avian Influenza and Newcastle Disease for diagnostic confirmation and genetic characterization. ⁸²⁰

Risk Environment

6.1 Political and security risk

6.1.1 Government effectiveness

6.1.1a Policy formation

Score: 50

6.1.1b Quality of bureaucracy

Score: 25

6.1.1c Excessive bureaucracy/red tape

Score: 25

6.1.1d Vested interests/cronyism

Score: 0

6.1.1e Corruption

Score: 25

6.1.1f Accountability of public officials

Score: 25

6.1.1g Human rights risk

Score: 25

6.1.2 Orderly transfers of power

6.1.2a Orderly transfers of power

Score: 25

6.1.3 Risk of social unrest

6.1.3a Risk of social unrest

Score: 25

6.1.4 Illicit activities by non-state actors

6.1.4a Risk of terrorism

Score: 25

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 25

6.1.5 Armed conflict

6.1.5a Presence or risk of armed conflict

Score: 50

6.1.6 Government territorial control

6.1.6a Government territorial control

Score: 0

6.1.7 International tensions

6.1.7a International tensions

Score: 75

6.2 Socio-economic resilience

6.2.1 Literacy

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 65.26

6.2.2 Gender equality

6.2.2a UNDP Gender Inequality Index score

Score: 45.1

6.2.3 Social inclusion

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 18.96

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 0

6.2.4 Public confidence in government

6.2.4a Public confidence in government

Score: 0

6.2.5 Local media and reporting

6.2.5a Robust, open, diverse local media and reporting

Score: 50

6.2.6 Inequality

6.2.6a Gini coefficient

Score: 49.7

6.3 Infrastructure adequacy

6.3.1 Adequacy of road network

6.3.1a Adequacy of road network

Score: 25

6.3.2 Adequacy of airports

6.3.2a Adequacy of airports

Score: 50

6.3.3 Adequacy of power network

6.3.3a Adequacy of power network

Score: 25

6.4 Environmental risks

6.4.1 Urbanisation

6.4.1a Urban population (% of total population)

Score: 68.26

6.4.2 Land use

6.4.2a Change in forest area (percentage points)

Score: 41.89

6.4.3 Natural disaster risk

6.4.3a Natural disaster risk

Score: 25

6.5 Public health vulnerabilities

6.5.1 Access to quality healthcare

6.5.1a Total life expectancy (years)

Score: 41.5

6.5.1b NCD mortality rate

Score: 45.09

6.5.1c Population aged 65+

Score: 93.03

6.5.1d Tobacco use (% of adults)

Score: 0

6.5.1e Level of adult obesity (%)

Score: 85.06

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 56.63

6.5.2 Access to potable water and sanitation

6.5.2a Access to potable water

Score: 66.95

6.5.2b Access to at least basic sanitation facilities

Score: 38.91

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 72.92

6.5.3 Public healthcare spending levels per capita

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 3.25

6.5.4 Trust in medical and health advice

6.5.4a Trust medical and health advice from the government

Score: 50

6.5.4b Trust medical and health advice from medical workers

Score: 50

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